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ASIATIC CHOLERA: 

ITS OKIGIN AND SPEEAD IN 

ASIA, AFRICA, AND EUROPE, 

INTEODUCTION INTO 

AMERICA THROUGH CANADA; 

REMOTE ' AND PROXIMATE CAUSES, 
SYMPTOMS AND PATHOLOGY, 

AND THE 

VARIOUS MODES OF TREATMENT ANALYZED. 



By R. NELSON, M.D., 

Health Commissioner during the first two invasions, 1832, 1334; President of 
the Medical Board for the District of Montreal. 



NEW YORK: 
WILLIAM A. TOWNSEND, PUBLISHER, 

434 Beoome Street. 

1866. 






Entered according to Act of Congress, in the year 1866, by 

R. NELSON, M.D., 

In the Clerk's Office of the District Court of the United States for the Southern 

District of New York. 









John Medole, Printer, 
No. 193 Pearl Street, N. Y. 









PREFACE. 



It was through medical journals, commencing in 
1820, that my attention was first drawn to the cholera 
of India, said to prevail in an epidemic form, and to 
its subsequent spread through the rest of Asia, the 
east of Africa and into Europe, even into the western 
confines of the latter continent. In the absence of 
personal observation, I became as thoroughly conver- 
sant with the malady as reading could afford informa- 
tion. But I could not help being struck with the 
great discrepancy in opinions and doctrines promul- 
gated. On one point only all were in perfect accord; 
that point was one of patent fact — a description of 
the appearance of a patient and the phenomena man- 
ifested in every case. In all other respects they all 
disagreed, as doctors — doctors in medicine and doc- 
tors in theology — only can differ and argue. 



IV PREFACE. 

Thus prepared by reading, and rendered skeptical 
by conflicting doctrines and opinions, I entered upon 
the duHes of my office. Daily reports were sent in to 
the Board of Magistrates, and to my office as execu- 
tive officer of the Medical Board, from practitioners, 
and other sources of information. It will be admitted 
that under these circumstances I was favorably placed 
to become well acquainted with the pest from its first 
appearance in America, in 1832, and the second inva- 
sion in 1834; nor have I remained unmindful of subse- 
quent irruptions. 

Of the contents of this book I have often spoken, 
for years past, with medical men, and as often have 
been urged to publish my views. I do so now, princi- 
pally to fix a point in history: 

The introduction of a new malady into a neiv coun- 
try, and to record the experience I acquired in the 
beginning, and which has been confirmed by every 
case since then. Many of my statements come into 
direct collision with those of previous and even of 
present writers. The only apology I can offer for 
the difference is, mine are the result of personal 
observations carefully made on the patient, unbiassed 
by abstract theories, and an erroneous physiology, 



PREFACE. V 

which possesses nothing in common with Asiatic 
cholera. 

R. NELSON. 

P. S. Since writing this book, some of my state- 
ments have met with corroboration this present sea- 
son, namely: 1st. Cholera broke out on board a 
French vessel a few days out of port. It soon had 
selected its victims, and then ceased; the remainder 
of the passage, which was of some weeks' duration, was 
completed in perfect health, when the vessel arrived 
at Guadaloupe, all well. 2d. An apparently healthy 
ship and passengers enter a new (land) atmosphere, 
and within a day or two the pest breaks out among 
the passengers who had escaped the pestilence on 
board, and communicate it to a healthy people, 
among whom it makes dreadful ravages. (See Sections 
66, 67, 74, 87, 88.) 3d. Two steamers, from England, 
experience an outbreak on board a few days after 
leaving port. (Sec. 78.) But the vessels arrive with 
cholera still on board; the passage being of only two 
weeks' duration, the pest had not the usual period of 
time to select all the susceptible, and then cease. 
One put into Halifax, is placed in seclusion, and now, 



VI PREFACE. 



in a new (land) atmosphere, renews its activity, as has 
ever been the case. Some passengers escape from the 
quarantine inclosure, travel rapidly through a per- 
fectly healthy country, take ill and die in the new 
atmosphere. These three vessels afford several other 
points corroborative of my statements, but which I 
do not notice, that I may not enlarge this book use- 
lessly. 

B. N. 



INDEX 



Adipose tissue diminished, 208; Omentum, 200. 

Aeration of blood arrested, 118. 

Animals attacked — A horse, 176; Poultry, Fishes, 177. 

Ascites, hydroth'>rax, etc., drained away, 204. 

Atmosphere — Choleraic, 41; Cholera carried by, 45; Change 
of, no protection, 88; While in infected, less risk, 
removal to a healthy one injurious, 155. 

Attacks — Sudden, 57; At Suedie, 58; While riding, 106; At 
breakfast, 57; None other than the exposed, 208. 

Attack, a second one, 172. 

Bile — Secretion of, arrested, 139. 

Blood, 185; Quality of, 194; Salts in, 196; Globules, pro- 
portion of, explained, 194; In the cyanosed state, 186; 
Difference between healthy and choleraic, 194. 

Cesarean operations, 126. 

Calorification arrested, 121; Temperature reduced to 70°, 
122; Cold breath, 124; Interior of body cold, 126; 
Stools cold, 123; A warm enema returned cold, 125; 
Saline injections cooled in passing through the body 
129; Temperature measured by thermometer, 128. 

Catalysis, 138. 



Vlll INDEX. 

Cause, remote, importance of studying, 29; Attributed to 
the atmosphere, 41; Absurd opinions, 42; Humid 
miasms, 44 to 47; Low grounds and high make no 
difference, 49; Dry places, 51, 52, 54; High land — 
Mysore, Ghauts, Ararat, Lebanon, Caucasus, Him- 
malayas, etc., 52. 

Cholera— Common, 92; Cases, 95, 96, 97, 98. 

Cholera — Asiatic. 109. 

Cholera — Carried by caravans, 73. 

Cholera — Carried by ships to Muscat, 61 ; By frigate Topaz 
to Mauritius, 66; By Pic-Var to St. Denis, 67; By 
frigate Leander to Trinchimallee, 74; By a brig to 
Astrachan, 75; By frigate Abercrombie, 76; To Col- 
lapore, 77; By French frigates Cybele and Cleopatre, 
78; By mercantile fleet into Canada, 147; The Kobert 
from Cork, 148; Constantia from Limerick, Elizabeth, 
Carrick, brig Brutus, ship Brutus, 148; By canal 
boats, 58; By pest steamer Voyageur, 155; By troops, 
56. 

Cholerine and diarrhoea, 113. 

Choleraic poison converts a portion of the system into the 
liquid form, 219. 

Choleraic Poison leaves no pathological trace, 103. 

Cholera, cases of, all alike, 109, 110, 111, 114. 

Cholera, cases of, rapid, 115. 

Cholera, cases of, mild, 111, 112. 

Cold country or situation made no difference, Moscow, 
North of Europe, Edinburgh, 21, et seq. 

Circulation arrested, 119; Capillaries cease to act, 189; Ar- 
teries and veins equally rilled, 190. 



INDEX. IX 

Cleanliness no preventive— Palace of a prince, 79; Among 
the wealthy, 161, 162; Mortality among the wealthy 
statistically greater than among the lower orders, 162. 

Compound radical theory, 216, 217, 218. 

Congestion in cranium, 191; A convenient word, 192. 

Conquest arrested, 89. 

Contagionists, Non-, 39. 

Contagion — see Itinerary; carried to Pan well by a prisoner, 
59; By Caravans, 73; See ships, boats, troops, etc., 
56, 60; Carried by clothing, 62, 63; Great fair at Nij- 
ne-Novgorod, 65; By a bed, 158; By a raft, 158; By 
a drover, 158; By a canal boat, 158; Miss Hughes, 
173; By immediate intercourse, 159; From person to 
person, 55; Dr. Labrousse at Bourbon, 67. 

Cramps, 132. 

Cures supposed to have been made, 259. 

Cyanosis due to non-aeration, 118; Stasis of blood in rete 
malpighi, 140; Soon disappears in short cases, 141; 
Persists purple in "typhoid state," 110. 

Curious catalogue of reputed remedies, 220. 

Digestion arrested, 120. 

Disease, definition of, 101 ; Asiatic cholera not a disease, but 
simply a poison, 92. 

Drunkards escape, 90, 162. 

Duration of cholera in one place, 86, 87, 88. 

Enclosed places escape, Gurruckpore jail, 66; Baron Me' 
lius, 67; In Montreal, 180. 

Erroneous physiology, 184, 185, 222. 

Exclusion by the Moravians, and escape, 68; Sequestration 
of houses in Moscow, 69; M. de Lesseps in Egypt, 



INDEX. 



70; Passes at Sankerredroog, 71; Teheran, 73; Bun- 

gheet Sing, 82. 
Exudation through the skin, not perspiration, 137; a colli- 

quate oozes out, 208, 209. 
Galvanism useless, 238. 
Garrison at Montreal, 174, 
Infection, range of, 85; How soon manifest, 78. 
Inflammation cannot be excited, 197; Of semilunar gan^ 

glion, 198. 

Itinerary in Asia, Africa and Europe, 1 to 28; In Canada, 

144 to 183. 
Incubation before out-break, 78, 86; Seldom exceeds four 

days, 108; On shipboard, 148, 155, 212. 
Heart, 187; Liver, 201; Spleen, 202; Kidneys, 203. 
Mental faculties remain perfect, 142; Perverted sensation 

of heat, 117, 131. 
Not exempt-medical practitioners and nurses, etc., 39; Pa- 

tient with variola, fever, etc., 264. 
Quarantine in Canada, 145 to 150. 
Serous membranes all dry, 204. 

Secretions arrested, why, 133; Varicose ulcers, sinuses, 
gonorrhoea, cease to secrete, 204.; Of bile, 139; Of 
urine suppressed, why, 133. 
Religion as a prophylactic by the king of Siam, 83; propa- 
gated by the ceremonies of, 80; Juggernaut, 81, 
Mecca, 84, Canada, 137. 
Strangury explained, 135; Not in females, 136. 
Stomach and intestines contracted, 199, 
Thirst, cause of, 143. 



INDEX. XI 

Treatment, 220; Examined in detail, 223; bleeding, 223; 
Calomel, 225; Emetics, 228; Purgatives, 230; Enemas, 
233; Metastasis, 226; Sinapisms, epispastics, cautery, 
red-hot iron, scalding water, nitric acid, 227; Seda- 
tives, 232; Opium abused, 234; Stimulants, 234; Bath, 
warm, 235; Astringents, 236; Drinks, 237; Quinine, 
per or am et anum, 239; Acupuncture of the heart, 
238; Charcoal, 240; Oxygen gas, nitrous oxide, 241; 
Chloroform, 242; Saline venous injections, 243: Effect 
of injections, 244, 245, 246, 247; Farrago of treatment 
completed, 248. 

Treatment, sound: Opium, merits of, 249, 250; Drinks, made 
of tartaric acid, 352; Hot applications, 254; Cold 
bath, 255; Medical treatment uncertain and confused, 
256; Dialogue between Honesty and Pretence, 257; 
Expectant treatment, 258 ; Quietude necessary to 
arrest vomiting, 260, 261; Opiate, proper time to 
give, 262; Proper quantity, 263; Diarrhoea- cholerine 
treated, 264, 265. 

Vox cholerica, 130. 



ASIATIC CHOLERA. 



CHAPTER I. 

ORIGIN AND ITINERARY. 



The 19th century is remarkable for the great 
events that have taken place since its commencement, 
and a short time previously. In it the knowledge of 
steam, its powers, the means of controlling it, its uses 
as a substitute for bodily and manual labor, and its 
I complete obedience to the hand of man, have been 
perfected. 

Chemistry, already in its infancy, has become an 
exact science. 

Electricity and magnetism have advanced from 
being mere toys to a grade of the highest utility. 
Geology has disinterred the long buried almanac of 
the globe, brought clearly into light the reign of ex- 
tinct creations, overwhelmed and hidden since mil- 
lions of years have passed away. These are only a 
2 



14 ASIATIC CHOLEftA. 

few of the remarkable occurrences; but the one which 
distinguishes this century more than all others of 
which history makes mention, in relation to man, is 
the stupendous plague called Cholera. Stupendous 
from its wide spread malignancy over every conti- 
nent; stupendous from the millions of victims it has 
swallowed; stupendous from the rapidity of its 
spread; stupendous from the few brief moments of life 
it allows to those it attacks: apparently capricious 
in its selections, it has desolated some places, spared 
others; terrified nations, arrested the march of armies, 
turned conquest into defeat, laughed at science, and 
baffled the efforts of man to arrest its empire. 

1. Sporadic cases of cholera have been known in 
all historic ages, from that in which the great Hip- 
pocrates flourished until now, and is mentioned in all 
treatises of medicine. In India it has been long 
known. Bontius, Lind, Dellon, &c, almost all 
writers on the diseases of that country, make special 
mention of it. It is said to have prevailed in an epi- 
demic form in the Bengalese territory in 1762, when 
it carried off 30,000 natives and 800 Europeans in 
one season, and then ceased. 

2. A more recent account says that the Govern- 
ment of India became cognizant of an increase of the 
malady among the natives ten years, at least, before 
it assumed the character of terrible devastation that 



ORIGftf AtfD iTMEBARr. 15 

distinguished it in 1817; while, in all these ten 
years, not one case occurred among the European 
population, and during that period not one case was 
admitted into the General Hospital of Calcutta. It 
still maintained the simple and sporadic character 
noticed for many years; that is, single cases, here 
and there, now and then, happened apparently spon- 
taneously and without assignable cause, not spread- 
ing from one to another individual, and still less ex- 
isting as an epidemic. 

3. The Government of Bengal was officially in- 
formed on the 28th of August, 1817, that a sudden, 
violent and spreading irruption of cholera had oc- 
curred in the populous town of Jessore, the capital 
of the Sunderbunds, situated in the delta of the 
Ganges, sixty miles from Calcutta; and that 10,000 
of the inhabtitants had died in a few weeks. The 
report stated: " The inhabitants, astonished and ter- 
rified at the unaccountable and destructive pesti- 
lence, fled in crowds to the country as the only 
means of escaping impending death. So unforeseen 
and appalling was the attack, the public function- 
aries, in extreme consternation, closed the civil 
courts of the district, and business of every descrip- 
tion was abandoned for a time. In the course of a 
few weeks 10,000 of the inhabitants perished in this 
single district. 7 ' 



16 ASIATIC CHOLERA. 

It reached Calcutta on the 1st of September, 
whence it spread like radii from a centre to all 
points of the compass. 

4. Although its origin is generally located at Jes- 
sore, it is asserted that it ravaged the banks of the 
Burrampooter early in June, reached Silket, in the 
east, and spread to the confines of Balasore and the 
provinces of Behar, in the east. To the northwest 
of Jessore it attacked Patna and Dinapore, July 
11th. Following the course of the Ganges and its 
tributaries, it reached and attacked the camp of the 
Marquis of Hastings, in Bundelcund, on the banks of 
the Sinde, a tributary of the Jumna, on the 6th No- 
vember. The invasion was so sudden and violent 
that mounted men were stricken from their steeds, 
fell and died on the road. The roads were encum- 
bered with ill, dying and dead of the army, and its 
followers, more numerous about an Indian army than 
the army itself. But this irruption, though astound- 
ing, was soon over; for, having commenced on the 6th 
November, no new cases occurred in the camp after 
the 8th December. However, the pestilence still fol- 
lowed in the track of the army, or rather the army 
sowed its seeds all along the roads, rivers, and ways 
of travel, infecting village and town in succession 
throughout Bundelcund, and spread to the provinces 
of Behar, Malwah, Candish, overshadowing nearly 



ORIGIN AND ITINERARY. 17 

all the Deccan. It killed 10,000 in the town of 
Banda, and all the neighboring towns were similarly 
oppressed. One of these towns, Kotah, lies on the 
east side of the Chumbul, and is built upon a dry 
rock; but the aridity of the location afforded no san- 
itary protection, since 100 persons perished daily; 
the surviving inhabitants, struck at last with dismay, 
fled the city. 

5. Two offshoots of the pestilence appear to have 
set out from the town of Saugur, the westerly one 
going to Kotah, and the southern one, going due 
south, attacked the forces stationed on the Nerbundah, 
advanced through the states of Nagpore and Poonah, 
passed through Seringapatan to the extreme point of 
India. The westerly one from Kotah followed the 
coast of Malabar. An eastern branch followed the 
coagt of Coromandel, 

6. Each of these offsets invaded town after town, 
village after village in succession, regardless of topog- 
raphy, high or low land, mountain, plain or swamp; 
nor was the high Ghaut-range capable of presenting 
a barrier to its destructive march. 

7. Northwardly it reached Fyzabad and Lucknow 
in April and May, 1818. At Gurruckpore it carried 
off 30,000 of the inhabitants, while, during this ap- 
palling devastation, not one of the prisoners confined 
in the jails took the pest. The high mountains that 



18 ASIATIC CHOLERA. 

separate Hindostan from Nepaul were invaded, as 
well as the high table land of Patna and Rhatgoun, 
4,000 feet above the sea; Katamandoo, in Nepaul, 
was attacked in 1818, and also the south flank of 
those almost impassable heights; and in 1819 it 
broke out in Siam, Cochin China, beyond that range. 

8. In October, 1818, Madras suffered, and thence 
cholera reached Candy, the capital of Ceylon, at a 
great height above the sea, in December. Com- 
mencing at the coast, it spread to the interior of the 
island. 

9. We have now traced the course of the pesti- 
lence from its cradle in the Sunderbunds, eastwardly 
to the confines of Cochin China; northwardly to the 
Himmalayas; westwardly to Bombay; and south- 
wardly to Cape Comorin, and into the island of 
Ceylon. Let us now follow its course beyond India 
over the sea into Sumatra, Borneo, the Moluccas, and 
the Philippines, into China. 

!()• Malacca, the extreme southern point of the 
Birman Empire, was attacked August, 1818; the pesti- 
lence was carried over to the island of Penang in 
the Straits; and in 1819 it spread through Sumatra. 
The town of Batavia alone lost 17,000, and the whole 
island 102,000, according to the Dutch statistics. Java 
suffered in April, 1821. The destruction in these 
places, like in Borneo, was appalling. 






ORIGIN AND ITINERARY. 19 

11. Manilla was attacked early in 1820, where the 
death of 15,000 victims alarmed the people to fury, 
who rose up against the foreigners and made a fright- 
ful massacre of them. 

12. Traveling northwardly the cholera reached 
Canton in 1820. Bankok, in Siam, lost 40,000 in 
1819. Nankin and Pekin suffered in 1823. 

13. Southwesterly traveling across the sea it in- 
vaded the African islands, Mauritius and Island of 
Bourbon. The Topaz frigate, from Calcutta, anchored 
in Port St. Louis, Isle of France (Mauritius), at the 
end of November, 1819. Several of the crew had 
died of cholera on the passage. The captain refused 
to submit to quarantine; his people landed, infected 
the town, carrying off 20,000. (But the governor, 
Farquhar, perhaps to screen the captain of his 
haughty disobedience of the quarantine laws, re- 
ported the number at 7,000 or 8,000.) By strict 
measures adopted, the remainder of the island was 
spared. 

14. Baron Melius, the French governor of the 
adjacent island, Bourbon, at once interdicted all com- 
munication with his colony. Still, in spite of severe 
but wise measures of the governor, the pestilence 
was brought there by the cupidity of a trading vessel, 
Pic-Var, which left Mauritius July 7, 1820. On the 
14th cholera broke out at St. Denis. The inhabitants 



; 



20 ASIATIC CHOLERA. 

fled at once; the authorities surrounded the place 
with sentinels, kept up a most vigilant seclusion. 
Success was the result and the reward ; the pest 
spread no further into the county; it was confined to 
the town, in which 259 were attacked, of whom 178 
died. 

15. August 6th, 1818, it reached Panwell, separ- 
ated from Bombay by a strait crossed daily by 
boats. On the 9th a passenger from Panwell intro- 
duced the pestilence into Bombay and Salsette, 
whence it spread along the whole coast of Malabar. 

16. By the extensive commerce of Bombay it was 
carried across the gulf to Muscat, in July, 1821. It 
soon broke out in the islands of Ormus and Kishme, 
at the entrance of the Persian Gulf; and by August 
it extended up the coast to Bender- Abassi, where the 
destruction was so great that the bazaars were closed, 
houses abandoned, and the dead lay in heaps un- 
buried in the streets. September 6th it broke out at 
Shiraz, a hundred miles up the coast; here one of the 
first families attacked was that of the Prince Royal 
of Persia. One of his wives, his mother, and many 
Georgian beauties in his seraglio, besides some of his 
children, were carried off. The mortality was 6,000 
out of a population of 35,000. He fled, with his harem 
and suite, from the fury of the pestilence. 

17. Continuing its northwardly route it invaded 



ORIGIN AND ITINERARY. 21 

the towns of Yerd and Ispahan, where 25,000 fell its 
victims. Cachan, Koms and Teheran suffered, on its 
way to Tauris, in 1822. Boats carried it to Bassora 
and Bagdad, where it swept away one-third of the 
population. In July it infected Mosul, north of 
Bagdad, marched westward into Syria, and broke 
out at Aleppo, in November, 1822, spreading to An- 
tioch, etc., along the coast of the Mediterranean to 
Tripoli. 

18. Ascending the Caspian Sea it reached Astra- 
chan, near the mouth of the Volga, in September, 
1823, where the attacks and deaths were rapid. The 
Russian Government sent at once six medical officers 
to examine into the disorder; it also took wise, ener- 
getic and absolute measures to prevent it from 
ascending the river. These measures were effective 
for a while; but commerce broke down the barriers. 
An infected brig from Bakou, on the west coast of 
the Caspian, entered the Volga July 20, 1830, gave 
the disorder to Astrachan a second time, where 4,043 
died. It spread to Saratof, August 12; Samara was 
infected September 3d, Kazan the 9 th, and by the 
12th a few cases appeared in Moscow. 

19. We will not follow its other eastern route 
through Russia to Nijne-Novogorod, where it broke 
out August 27th, and thence spread through the centre 
of Russia. There is some uncertainty whence this 

2* 



22 ASIATIC CHOLERA. 

irruption came. Some assert that it was due to the 
great annual fair of 100,000 merchants assembled to 
purchase the costly shawls and furs that came from 
Orenburgh — goods that had been infected and lay 
there since the previous year; others say that it might 
have been brought by travelers from Saratof, where 
it raged fifteen days before. September 3d it reached 
Kostroma, and many towns and villages on the route 
to Moscow. 

20. By another route it crossed from the Volga, 
where this river approaches the Don, and descended 
this last named river to the Sea of Azof and the Black 
Sea coast in September, reaching Sebastopol in Octo- 
ber, and broke out in Kischrif in December. Its 
ravages among the Cossacks of the Don were fright- 
ful; out of 54,000 cases 31,000 died — that is, out of 
seven patients six died ! 

21. About the end of September, 1830, cholera 
broke out at Moscow. On the 29th a military cordon 
was established around the city, whose office was to 
prevent egress and ingress. Strict quarantine was 
exacted of all — even the Emperor himself obeyed the 
law, and underwent eight days 7 quarantine on his 
road to Twer. Mortality was great here throughout 
October and November, but diminished, as usual, 
after a while, by the 18th December. The popula- 
tion was 250,000, of which 8,130 died, equal to one in 



ORIGIN AND ITINERARY. 23 

25, a much smaller number tlian was expected; but 
this diminution was due to the cordon, the strict mili- 
tary discipline and quarantine, and to the closure of 
infected houses and places. A triple line of posts 
preserved St. Petersburg. Orders were sent to the 
people to lay in provisions for at least one year, to 
meet the wants of seclusion, should that become 
necessary. 

22. The disorder still existed in January, although 
a severe winter had frozen all travel and communi- 
cation. Still, all the sanitary regulations were kept 
up until the end of April, in consequence of the ex- 
perience gained at Kievv, where, the disorder having 
ceased in November, all restrictions were removed; 
but unfortunately so, for only fifteen days after the 
relaxation of all restriction it broke out again, on 
the 1 5th December. 

23. The Russian army moving on Poland was the 
rapid means of carrying the pest westvvardly. The 
troops of this army were drawn from the Ukraine 
and the provinces of Koursk, where cholera had 
raged the previous autumn. The violence of the 
plague did not diminish with its entry into a northern 
climate, for in April and May more than half of the 
attacked died, and this frightful proportion was ex- 
clusive of the military loss. Other troops coming 
from Bender and the shores of the Dnieper spread 



24 ASIATIC CHOLERA. 

the pest among the people in February. With this 
army, cholera entered Poland at the southeast corner 
of the kingdom, on its march to the northwest, its 
destination being Warsaw. At the end of March it 
ravaged Lublin. By the 1st of April the hospitals of 
Siedlee became crowded with patients affected with 
cholera. On the 10th it broke out among the pris- 
oners and the wounded brought into Praga, a 
suburb of Warsaw, on the opposite side ef the Vis- 
tula. The same day it was discovered in the Polish 
army after the battle of Iganie, proving fatal to the 
conquerors by the infected spoils collected from the 
slain of the vanquished. 

24. The Russian Government appointed an ex- 
traordinary committee in April, whose office was to 
discuss and decide whether it was necessary to have 
a general purification of the goods left in Moscow 
during the winter after the cessation of the plague 
there. On this committee there were several mer- 
chants, besides disinterested scientific men. A ma- 
jority was to decide. It is easy to see that cupidity 
would overpower honesty; accordingly a majority of 
votes decided that purification was unnecessary. 
Acting on this dangerous advice, the Government is- 
sued a circular to the several European powers to 
justify its conduct in not purifying these goods be- 
fore their export. The result soon became apparent, 



ORIGIN AND ITINEEARY. 25 

for the boats which carried these goods down the 
Dwina and its tributaries to Riga carried also the 
contagion, which broke out in Riga 25th May. 

25. With the irruption of the fell demon there 
also broke out alarm. On the 3d June sixty vessels 
fled in haste from Riga, and forty-two had already 
passed the Sund. Four of these vessels were des- 
tined to England, and one that was infected entered 
the port of Montrose in Scotland, where cholera 
spread lightly in June, but of which no official notice 
was announced. 

26. An official report declared that 306 cases and 
94 deaths had occurred in Sunderland, by Octo- 
ber 26th. 

However, Mr. Hall, surgeon of H. M. ship Teme- 
raire, an hospital ship in the Medway, says that be- 
tween the 7th and 9th August he had thirty cases, 
persons of all ages, even to infants at the breast. 
Drafts from Portsmouth, Plymouth, etc., who arrived 
to join the men-of-war here, men in robust health, 
took the disease within the first and second day of 
their arrival. The infected ships were sent into 
quarantine at Stangate, ten or twelve miles distant, 
by which means the pest was prevented from spread- 
ing there and then. 

To return to Sunderland, it is affirmed that chol- 



26 ASIATIC CHOLERA. 

era was brought into that town through clothing col- 
lected from the dead in the Baltic. 

27. The cold winter of Northumberland afforded 
no obstacle to its propagation; even Edinburgh suf- 
fered in February, 1832. 

28. The object of writing this book is to record 
the first entry of a new pestilence into a new coun- 
try, to be substantiated by positive and precise data. 
But it was deemed proper to precede this event by a 
few words on its origin and migration towards the 
" New World." Therefore it is that we have given 
the foregoing rapid sketch of a pestilence that has 
spread its long arms to the four points of the com- 
pass, reaching from the place of its birth in the Sun- 
derbunds to the Baltic, and thence into England — 
the leap-off point from the old to the new continent. 

However, before touching on the history of its ar- 
rival into the towns and parishes on the St. Law- 
rence, and its subsequent spread in America, we 
must not omit a summary and expos^ of the import- 
ant and interesting opinions of writers on its origin 
or remote cause. This will constitute the second 
chapter, in which we shall have to repeat much of 
the itinerary already stated in this first chapter. 
After the fourth chapter, we shall trace it — lead, as 
it were, by the hand — across the ocean into the 
" New World." 






CHAPTER II. 

REMOTE CAUSE. 

In this chapter on the remote cause will appear a 
succinct notice of opinion set forth by non-conta- 
gionists, and a history of its march from place to 
place, and from individual to individual, proving its 
contagious character. 

29, The remote cause of all diseases, especially of 
pests, is the most important point to become ac- 
quainted with; for with this knowledge the practi- 
tioner will know what precautions ought to be 
adopted against the disorder and its spread. With 
this it is the duty of the magistrate to become thor- 
oughly acquainted, in order to arrest its invasion of 
his country, and the spread of an infectious disease 
among his people, since he is appointed to watch 
over, care for, and protect them. To attain this 
knowledge, the widest range of research and discus- 
sion must be accorded to all men who undertake an 
examination into the subject. Without a knowledge 
of the remote cause of a pestilence, no well ordered 
measures can be employed to exclude the misery it 



28 ASIATIC CHOLERA. 

Will carry into a country, or measures to mitigate its 
power for evil when once it prevails; without such 
knowledge, every precaution taken, every means and 
effort to control it, will amount to confusion, great 
errors, injurious restrictions, even oppression, while 
all the time the best and most anxious intentions are 
in full exercise. 

30. In the early days of Indian cholera, practi- 
tioners appear to have vied against each other which 
should be the most ardent argumentator in support 
of the assertion that the pest was due to something 
else than contagion. 

There always appears to be something peculiar in 
the medical mind which prompts the votaries of that 
obscure science to seek elsewhere for explanations 
than among the simple, every-day facts that strike 
the common sense of the vulgar. This has ever been 
the case on the occurrence of every known pest, and 
never yielded to common sense and observation until 
the imaginative, metaphysical and argumentative 
practitioner has been forced to abandon his fine-spun 
hypothesis. 

Let us refer to a few of the pests that have afflicted 
mankind, and we shall find that the same contentious 
professional spirit prevailed in every one of them. 

31. Plague, as it is emphatically called, is one ex- 
ample, which, until very lately, eminent partisan 



REMOTE CAUSE. 29 

men, but not the vulgar, attributed to climate, to ter- 
restrial exhalations, filth, etc. Even such men as 
Baron Desgenettes, a man of unquestioned science, 
but also a man of crotchets, boldly contended that 
plague was not contagious; and, to support his as- 
sertion, mixed freely among the French infected in 
Egypt; even went so far as to inoculate himself with 
the matter of the pestilential bubo; and because he 
escaped, cited his case as proof irrefragable of his 
promulgated opinion. Several enthusiastic young 
French doctors imitated the example set by their ad- 
mired chief, inoculated themselves, and died. But 
to the partisans of a theory the infection of the 
young doctors was easily explained and denied, or 
rather, ignored; the partisans, whose greatest merit 
is adhesion to previous opinions, boldly declared 
that the disease of these young enthusiasts was due 
to the common unseen cause — an epidemic — and not 
to the inoculation. Many medical writers appealed 
to the example afforded by the conduct of the com- 
mander-in-chief of the army going among the in- 
fected, and escaping. It was gravely asserted that 
he escaped because he had no fear of the disease. 
It is well known that Bonaparte, like any other 
great commander, would venture almost any thing to 
preserve the confidence of his army, which, if lost, all 
was lost. This story about fear was one of the 



30 ASIATIC CHOLERA. 

stalking-horses much paraded during the prevalence 
of cholera in Canada and in the United States. 

32. Another example of medical contention is to 
be found in Typhus. This fever arises sponta- 
neously in many places; and, when there is only one 
case, or only a few, here and there, it does not 
spread. This fact was the origin of the name 
Typhoid; but, said the originators of the new name, 
it is not typhus, because it does not spread — morbus 
contagiosus non est ! In certain epidemics of the dis- 
ease and period of its duration, there might, or 
not, be a cutaneous irruption of petechias, vibices, 
maculae, etc. Each of these accidents to the disease 
sufficed to furnish to the imagination of would-be 
profound observers several new names to a well 
known and heretofore well described disorder, such 
names as spotted fever, enteric fever; to autopsists, 
the names gastro-enteric phlegmasia, ulceration of 
the agminated and solitary intestinal glands, mere 
accidents to the disease; and lately we have been 
favored with a newer name — cerebro-spinal-arach- 
nitis! But when typhus spread incontestibly from 
person to person it was said to be infections, but not 
contagious, a distinction that tickled the author into 
the belief that he was a profound observer and a 
learned etymologist. 

33. Small-pox, another contagious disease, was 



REMOTE CAUSE. 31 

long ignored as such, and writers say that Syden- 
ham was not aware of the fact. It was first no- 
ticed in Europe in 572, and in 580 the Bishop of 
Avranches, in France, gave to it the name Variola, 
a Latin word of his own coining. It desolated Gaul 
and Italy, and in 580 Austregilde, wife of Gomtran, 
King of Bourgoigne died of it. She was so incensed 
that she forced a promise from the king that her two 
physicians, Nicholas and Donat, should be sacrificed 
on her grave as a punishment for not curing her. 
The crime was perpetrated. But variola had long 
been known in China. It was spread through Eu- 
rope by the Saracens who overrun the country. In 
Georgia the discovery of inoculation was made, and 
necessarily spread to Constantinople, where the 
famous Lady Montague learned it, and, returning to 
England, prevailed on the Princess of Wales to set a 
public example by having her children inoculated, in 
1716. This met with violent opposition by the pro- 
fession and the clergy. It took a long time to intro- 
duce it into France, where one of the first to undergo 
it was the daughter of the famous Montcalm, in 1764. 
34. A negro, from St. Domingo, brought variola 
into the army of Cortez in Mexico, June, 1520, 
where it annihilated whole villages and towns; the 
dead were too numerous to be buried, and the stench 
they created was so great that the houses were fired 



32 ASIATIC CHOLEXtA. 

and in them the dead burned. For a long time vari- 
ola, like cholera, was denied being contagious. 

35. Measles and scarlatina were also brought into 
Mexico about the same time as variola. All these 
diseases were hitherto unknown in America. 

36. Syphilis belongs to the above category, but 
for reasons that may be appreciated is passed over. 
Nor need I refer to the black-death and the Sudor 
Anglicus, both of them limited pests. 

The four pests mentioned are referred to simply to 
show that contagion, admitted from the first by the 
vulgar, has been generally denied for a while by the 
scientific; and is here introduced as a preparatory 
caution to the reader before he goes through the ex- 
amples cited in this chapter on remote causes, 
wherein it will clearly appear that cholera never 
preceded, but always followed, the arrival of infected 
persons. 

37. If we contemplate with unbiased minds the 
itinerary of cholera, in India and elsewhere, it will 
appear that the malady spread from individual to in- 
dividual; that it nowhere broke out until communi- 
cation had taken place with the affected; that it 
never, in a single instance, preceded the arrival of 
affected persons or things; that it often broke out 
almost immediately, and rarely later than thirty- 
six hours after the arrival of the infected; that ft 



&EM0TE CAUSE. 33 

rapidly attacked a fourth, more or less, of the inhab- 
itants of a place previously healthy, and that at least 
one-third of the attacked died; that, in a limited 
population, as that of a small town or village, or a 
concentrated one, as on ship-board, it soon ex» 
hausted itself, and ceased to rage in two or three 
weeks, or less time; that when a large town was at- 
tacked, it would take from two to three months to 
select all the susceptible, and then cease. 

From these data we are forced to believe that the 
remote cause is a poison generated in a patient, and 
emanated from his person. This theory is sup- 
ported by the fact that seclusion invariably pro- 
tected the secluded . We can only suppose it to be 
a poison which travels independently of wind, cli- 
mate, and .season — a poison given out by man, and 

carried by man to man. It is of no consequence 

- 
what place or person afforded the starting-point — it 

is individual in every patient and place; its cause is 

one and identical everywhere. Tropical heat made 

no difference in its violence or duration from that of 

a Russian winter; the atmosphere neither carried 

nor opposed its transmission, since it traversed the 

broad ocean against the trade-winds. Famine and 

peculiar food made no difference, nor did races of 

men, since it broke out with equal severity in the 

palace of the prince, the mansion of the nabob and 



34 ASIATIC CHOLERA. 

the rich merchant, and the hovel of the peasant and 
the poor. 

38. Why and how this greatest of all known pests 
originated and spread with appalling rapidity in all 
directions from the place of its birth, regardless of 
topography and seasons, has been largely commented 
upon, as might be well expected. For several years 
after its irruption in 1817, the majority of opinions 
for a while seem to attribute its propagation to 
occult causes outside of its victims; yet it is curious 
to notice that many " medical boards," that were 
appointed to report on the " disease," manifested in 
the reports a strong bias in favor of the opinion that 
it was propagated by the persons affected — curious, 
we say, to find the same names attached to the official 
reports, as are found outside of the reports on the 
title-page of numerous monographs written to pro- 
mulgate an opposite opinion, that is, that the disorder 
is not communicated — is not contagious; and these 
opinions are supported by " facts " and much meta- 
physical reasoning. It would seem that the officer 
charged with a responsible duty towards his govern- 
ment felt shy in making a hazardous and dangerous 
declaration, but who, left to a flighty imagination, 
felt himself now free from responsibility in his pri- 
vate writings. 

39. To deal fairly with the non-contagion theo- 



REMOTE CAUSE. 35 

rists, it is only justice to say that the faculty of 
Moscow, who knew the disorder only from printed 
accounts, were all contagionists; but shortly after 
they became personally observant of the plague, in 
1830, soon changed from contagionists to non-con- 
tagionists* This change of opinion they openly pro- 
claimed, and supported it by writings in which they 
justified their new opinion, by stating that medical 
officers, students, nurses, etc., escaped, although much 
exposed. To superficial observers these " facts" 
seemed irrefragable, and they are even now appealed 
to by medical men given to polemics. However, we 
must again do justice to the practitioners in Moscow, 
by recording that in a few weeks they once more 
changed opinion, seeing that the " facts" they relied 
upon had been erroneously observed, and that the sup- 
posed exempt were soon numbered among the vic- 
tims. It now became manifest that what appeared to 
be a fact yesterday, ceased to remain a truth after 
more extensive inquiry. 

40. This alleged impunity of exposed persons has 
been from the beginning and throughout the reign of 
cholera the one — the only — argument against the 
idea of contagion; and was, and has been, contested 
with a partisan mode of argumentation which has 
brought into strong relief the mental capacity of 
some of the writers for metaphysical reasoning, bril- 



&6 ASIATIC CSOLEBA. 

liant as well as confused ideas, and tenacity of pur- 
pose. 

41. Among the assigned causes that originated 
and perpetuated the malady Was the atmosphere— 
that convenient receptacle for the location of all 
kinds of medical ignorance. Chemical admixtures, 
physical admixtures, even metaphysical admixtures 
were declared to exist therein, and were proved to 
the satisfaction of each author, however widely they 
might differ one from the other. For at least fifteen 
years the medical press teemed with these lucubra- 
tions, caught up by the newspaper press, and made 
clear " to the meanest capacity." But a necessary 
condition for the atmospheric cause to operate was 
some anchorage ground in the patient — he must be 
11 predisposed" — he must have taken cold — his system 
must be in an " abnormal" state — his digestion must 
be disturbed, etc. 

42. Numerous equally absurd statements were put 
forth: atmospherical and terrestrial commotions were 
accompaniments, or rather causes, of cholera; rapid 
change of temperature from cold to heat ; baromet- 
rical fluctuations, unwonted meteors, whirlwinds, 
waterspouts, fogs, volcanoes and earthquakes, over- 
flow of rivers, geological changes that are continuously 
and silently going on. Influence of comets (the one 



EEMOTE CAUSE. 37 

seen in November, 1831 or ? 2), extraordinary Lumen 
Zodiacale, seen September 29th, 1829. 

43. Remarkable aurora borealis 1 7th January, 1830, 
and another in August; a new island upheaved in 
the Mediterranean; clouds of hitherto unknown green 
insects in the upper strata of the atmosphere, brought 
down on the tails of kites at Astrachan, reported 
by a learned naturalist (nothing like leather to 
fortify a city, said the cobbler). But Dr. Forster 
says: " I give little credit to this statement as a cause; 
for I ascended, on the 30th April last, to a height of 
6,000 feet in a balloon, and found none of these 
pestilential flies which some experimentalists pretend 
to have come down on the tails of kites." A tornado 
in Barbadoes; earthquakes in Venice and Parma. 
All the authors of the foregoing inanities seem to 
forget that cholera ravaged the world at least thirteen 
years before the occurrence of the foregoing state- 
ments. One of the casuists boldly declares: " I am 
convinced that if a premium were offered for the 
importation of cholera or yellow fever, by means of 
dress or bed-clothes in which patients had died, the 
thing would be found impossible. No mischief would 
arise r unless the importers of the bed-clothes could 
import the peculiar constitution of the atmosphere 
and the earth under the atmosphere where these 
maladies originate." What a waste of time and money 
3 



38 ASIATIC CHOLERA. 

to have taught such a man to write I Another phi- 
losopher says: " Specific local atmospheres produced 
by irregular streams of specific atoms from the interior 
of the earth. Perturbated electrical and magnetical 
states of the air and earth have been the hobby ridden 
by many a daring medical Mazeppa." 

44. Another cause assigned was great humidity of 
the air in some places, over swamps and deltas. 
This supposed cause was announced by practitioners 
who lived in humid localities, and who heeded not 
that cholera reigned equally supreme in arid countries 
— such as Arabia, where rain scarcely ever, or never, 
falls, the land parched to a great depth, and a spring 
of water so great a rarity as to be sought for at a 
distance. 

45. Others attributed it to vegetable and other 
putrefaction exhaled from low places; while it is well 
known that such putrefaction did not and could not 
be a cause, since aridity was the rule in some countries 
where cholera prevailed. Another statement, much 
in vogue for a time and widely disseminated by jour- 
nals and common newspapers, was that cholera fol- 
lowed the " great lines of commerce." We are left 
to suppose that it followed these lines as a mere 
traveling companion — never preceding commerce or 
lagging behind. The way the wind blew did not 
disturb the traveler, for he, cholera, traveled in the 






KEMOTE CAUSE. 39 

" wind's eye" rather than abandon his companion, 
commerce; and all this time the atmosphere was the 
abode of the pest that moved in a contrary direction. 
I well remember with what dogmatic assurance a 
merchant, newspaper editor, or other pretender to 
knowledge, would cut all statements short by throw- 
ing the hackneyed phrase in your face, " it follows 
the great lines of commerce " — reply to that, if you 
can ! 

46. While being carried, according to some rea- 
soners, by the atmosphere from place to place, it 
would descend to attack victims in one spot and spare 
an adjoining place, over both of which this atmo- 
sphere spread equally. Cholera would attack one 
side of a river, the road side, and neglect the other; 
attack the inmates of one house and not those of an 
adjoining one; attack some portions of a town and 
not others, while the same atmosphere enveloped all 
sides and over all equally. 

The foregoing statements are only a few of the 
many put forth and bandied about for several years, 
to the disgrace of the human understanding, and 
should not now be noticed were it not that there 
still linger some of those credulous or obstinate beings 
who are an annoyance to the profession. 

To descend from the extravagant and wild flights 
of imagination like the foregoing, let us notice some 



40 ASIATIC CHOLERA. 

of the more reasonable opinions at first put forth 
regarding the remote cause, or causes, of this dire 
visitation upon humanity. 

47. Moisture a remote cause. Let us examine this 
alleged cause. It was natural enough for practitioners 
living in the extensive flat, low and swampy country 
of the Bengalese territory — a country intersected in 
all directions by numerous dikes, rivulets and rivers, 
tributaries of the great Ganges, which opens into the 
sea through a nearly stagnant delta of many branches, 
called the Sunderbunds — to attribute its malignant 
character and origin to the nature of such a country, 
the capital of which, Jessore, low, flat and wet, like 
the country around for many miles. Besides this 
disadvantage, it is a remarkably ill kept and filthy 
city, containing a dense population. 

It is here that cholera is alleged to have first put on 
the malignant and spreading form. To these sanitary 
defects add the hot season, which commences in 
March under a south wind, the temperature rising from 
70° to 90°. The rainy season commences in June 
and continues until October, before which time the 
Ganges reaches its highest point, and inundates the 
countrv to a vast extent. The cool season, which is 
never cold, commences in November and lasts until 
February. During this time the sky is clear, the air 
cool and bracing, the thermometer ranging from 45° 



REMOTE CAUSE. 41 

to 75°, with winds mostly from the northwest. But, 
although it does not rain in this season, copious dews 
prevail at night, owing to the great daily evaporation 
and nocturnal precipitation. 

48. It is not to be wondered that the early writers 
on this pestilence should have attributed its new and 
malignant character to such moisture, and to a filthy 
city. Moreover, in this year, 1817, the amount of 
rain that fell was quite one-third more than in former 
year?. The inundations cut off communications, and 
thus increased the scarcity of provisions and deteri- 
orated the quality of what remained. 

The pestilence soon spread to Calcutta in apalling 
force, among the poor first, who are improvident and 
intermingle freely and without discrimination. It 
soon after attacked the better classes with equal viru- 
lence, but in less numbers, because they are less nu- 
merous and more guarded in their intercourse. By 
September the villages and towns for several miles 
around were all infected. 

49. Now, as if to baffle and joke with medical 
opinions and statements, the following indisputable 
facts occurred: While cholera traveled northwardly 
from Calcutta in this same year, 1817, between Agra 
and Delhi there are many villages situated in low 
grounds, but these all escaped, while Cawnpore, 
Meerhut, Agra and Delhi, all high and dry grounds, 



42 ASIATIC CHOLERA. 

suffered severely. The fortress of Jaragurth, 1,000 
feet above the plain, suffered greatly, and this while 
the inhabitants of towns at the foot of the mountain 
escaped. These high and great towns w^ere rendez- 
vous of trade, the government commissariat and 
troops. 

50. If only low places, like the deltas of the Gan- \ 
ges, the Euphrates and the Nile, etc., had been at- 
tacked, ?*ott-contagionists might say, with a strong 
show of probability, that cholera was due to marshy 
miasm. 

We shall now proceed to show that low grounds, 
swamps and deltas were no more obnoxious localities 
than the high, dry and healthy parts of the world. 

51. Dry grounds and high countries. The high 
mountains which separate Hindostan from Nepaul 
were invaded by the pest, as well as the elevated 
table lands of Nepaul, Patum and Rhatgoun, 4,000 
feet above the sea. Catmandou, on the lower range 
of the Himmalaya, at a height equal to the Pyrennes, 
suffered greatly. Surely, this is land high enough 
and cold enough to contrast with the steaming swamps 
of the Sunderbunds and that hot climate. 

52. The table land of Mysore, Darwar, Belgaum, 
Bengalore, all very high, over 4,000 feet above the 
sea, were attacked with equal fury and destruction to 
lower and hotter places. 



REMOTE CAUSE. 43 

Cholera crossed the Ghaut mountains that separate 
the east of India from the coast of Malabar, a moun- 
tain range as high as the Carpathians or the Pyre- 
nees in Europe. It invaded the town of Candy, situ- 
ated at a great height, in the island of Ceylon, as 
early as December, 1818, having commenced at the 
coast and spread to the interior. 

It ravaged the Pachalicks of Syria, and crept up the 
flanks and over the top of Mount Lebanon, in 1823; 
attacked the town of Tiberias in the winter of 1824; 
ravaged the Caucasus, the flanks of Ararat, the Him- 
malayas, where its violence and destruction were equal 
to what happened in low and hot places. Nor did 
the valley of the Jordan escape, a country 1 ,400 feet 
above the sea. 

53. Cold. Besides the elevated countries just 
named, which are naturally of low temperature, spe- 
cial mention may be made of the invasion of cholera 
in the north of Europe, where the country is flat, but 
not wet in the winter time, since all surface water is 
frozen over. The pest reached Moscow in October, 
and persisted there until its decline at the end of De- 
cember, 1830, a period of nearly three months, quite 
as long as it lasted in any invaded hot place — appar- 
ently the allotted period of its duration and power in 
every place it has invaded. From Moscow it traveled 
north to Yarosof, and, turning to the west, reached 



44 ASIATIC CHOLERA. 

Rybinsk, sixty leagues north of Moscow, on the road 
to St. Petersburgh, on the 19th March, 1831. This 
calendar of its march shows that the severe frost of 
an intensely cold country did not arrest it or alter 
the quality of the pestilence. 

It is now evident that neither low nor high lo- 
calities, nor warm nor cold regions made any, the 
slightest difference, in the spread of cholera, its 
severity or its nature. 

54. Geological formation. Cholera swept the sur- 
face of the Arabian deserts, a country so dry that 
showers are unknown, and where a spring of water 
is the object of a journey of 300 miles. It desolated 
the dry calcareous plains of Arabia with the same fury 
as the deltas of the Ganges, the Euphrates and the 
Nile, the swamps of the Volga and Dnieper; trav- 
ersed with equal ease the sandy plains of the Yemen, 
the basaltic declivities of Mauritius and Bourbon. 

55. Communication from place to place, and from 
person to person. In this section we shall notice 
only the best authenticated statements, without fol- 
lowing, seriatim, the propagation from Jessore, 
whence cholera ascended the Ganges, attacking 
place after place, each having previously given pas- 
sage to infected persons, until it reached the healthy 
banks of the Sinde, attacking first the numerous fol- 
lowers of the army of the Marquis of Hastings on 



REMOTE CAUSE. 45 

the 6th of November. By the 15th, in nine days, it 
spread throughout the camp, attacking all ages and 
sexes. In five days' time 5,000 deaths took place — 
one thousand a day ! In this short space of time it 
had reached its acme; then commenced to decline 
until the 23d, barely two weeks, when few cases oc- 
curred, and the deaths that now happened were 
those cases that had lingered on for several days. 

58. The Marquis, now that the storm was over, 
commenced to move his camp to the southeast, and 
did not complete the march until the 19th December, 
a period of 26 days. During this march, very few 
cases broke out, and none after the 8th of December. 
On the foregoing, Mr. Kennedy lucidly remarks: 

" A superficial acquaintance with the progress of 
cholera might lead to the supposition that its de- 
cline was connected with the change of locality pre- 
scribed by the commander-in-chief; but the history of 
the disease shows, on the contrary, that it had run 
its course of infection before the army quitted the 
banks of the Sinde, and the only benefit derived 
from the change of air was the assistance it afforded 
in the recovery of the multitude of people who lin- 
gered under the effects of an old attack. To ascribe 
the cessation of the pestilence to any virtue in the 
soil or atmosphere of the encampment by the Betwah 
would be little less than absurd; for the troops did 
3* 



46 ASIATIC CHOLERA. 

not arrive there until the 19th December, and a new 
case of cholera had not been observed during the 
eleven days which immediately preceded their ar- 
rival. If additional evidence were really necessary 
to settle this point, it would be amply furnished in 
the law of increase and decline appertaining to chol- 
era. This law informs us that when the malady has 
been developed in a camp it will continue its ravages 
through the period of one month or so, independent 
of locality — whether the infected camp be removed 
from a moist to a dry district, or from a low to an 
elevated station — and, at the expiration of the 
month, that the disease will die away sponta- 
neously." 

Staff-Surgeon Connell reported, Secnnderabad, 
May 20th, 1819: "A detachment of Europeans, 
under Major Wahab, arrived here with the cholera 
among them. The disease first attacked these troops 
at the Kistnah, after exposure to a great storm, and 
it continued with them to this place, although all the 
villages in their route were entirely free from the 
disorder. During the march sixty individuals per- 
ished, of whom eight were Europeans. On its ar- 
rival here, the detachment encamped about two 
hundred yards in front of our artillery lines. In 
this new situation, three Europeans and a number of 
natives died. Up to this time no case had occurred 



REMOTE CAUSE. 47 

in the encampment. The Europeans, however, of 
Major Wahab's detachment mingled with our party 
of artillery, and in the course of four or five days 
the disease began among the latter. * * * * * 
* * My sub-assistant, Mr. Hoskins, who was 
constantly with the sick, took the disease and died 
in twenty-four hours. Another sub-assistant, Mr. 
Steven, and Mr. Assistant-Surgeon McDougal were 
attacked. The disease traveled to* the bazaars and 
carried off many of the natives. The men of the 
Thirtieth regiment, who were in barracks, half a 
mile to the right, completely escaped. 

" I beg to add that Mr. Jones, Surgeon of the 6th 
Light Cavalry, has just arrived from Kistnah, by the 
same route as Major Wahab. Mr. Jones states 
that he found the cholera prevailing in every village, 
having commenced soon after the passage of Major 
WahaVs men. The inhabitants said they had got it 
from that detachment." 

57. After the irruption of 1824, Madras remained 
free and healthy until March, 1827, three whole years. 
But in July it suddenly broke out with violence at 
Jaulna, Hyderabad, etc.; during this irruption, the 
governor of Madras, Sir Thomas Munro, died. He 
sat down to breakfast at Pullycondah, a village 
twenty miles from Gooty. While at breakfast he 
was taken with the first symptoms, and said to his 



48 ASIATIC CHOLERA. 

secretary, who was beside him, "Get aivay; I am an 
infected man" and he died ten hours after. 

58. The pest reached Suedie, Mediterranean coast 
of Africa. But it was not very destructive here. 
However, Mr. Baker, British consul, reported that 
he had about twenty natives at work harvesting for 
him, all robust and healthy men. On the 9th July, 
at noon, when all appeared well, one was suddenly 
attacked, and shortly after others, with vomiting and 
cramps. Some died in three hours, others at sun- 
down, and all were dead before daylight. At this 
time strong westerly winds prevailed, which extended 
one hundred miles into the country, but did not drive 
the pest back to the east, whence it came. " It had 
traveled in the wind's eye" 

59. A detachment of troops brought a state pris- 
oner from Panwell, where cholera raged, -eighteen 
miles from Bombay, to Tannah in the island of Sal- 
sette, where it at once broke out. Thence it spread 
from village to village; but several villages, which 
had no intercourse with the infected places, escaped; 
however, after several months' immunity, they, too, 
were attacked through a renewal of intercourse. 

60. Cholera broke out in the Thirty-fourth regi- 
ment on its march from Bellary to Bengalore. All 
the villages on the route were healthy; but imme- 
diately after all the villages it passed through became 



REMOTE CAUSE. 49 

affected. A native soldier, traveling from Bengalore 
to Nundedroog, both places then healthy, passed 
through the Thirty-fourth, was attacked and died. 
Nagpore suffered in May. A brigade in perfect 
health arrived at Nagpore, now an infected place, on 
the 4th; on the 6th the malady broke out among the 
men with great mortality. The English army, in the 
best of health, encamped at Terayt, and received a 
detachment which had been attacked at the passage 
of the Jumna. Immediately after the junction the 
malady appeared in camp. A company which had 
lost some men on its march arrived at Trichinopoly, 
then quite healthy; the pest immediately broke out 
among the people and spread to the environs. The 
Fifteenth native regiment, affected with cholera, 
marched on Gooty; the villages through which it 
passed immediately became infected and desolated by 
this scourge, from which the inhabitants had ever 
before been exempt. 

61. Muscat, a seaport at the extremity of the 
Arabian peninsula, much frequented by traffic from 
Bombay, where cholera prevailed, became infected 
in July, 1821. About the same time the islands of 
Ormus and Kishm6, at the mouth of the Persian Gulf, 
became infected by trading vessels. Bender Abassi 
sunk beneath its rage, and in a short time one-sixth of 
the inhabitants perished; the bazaars were closed, the 



50 ASIATIC CHOLERA. 

houses abandoned, unburied dead lay in heaps in the 
streets, the surviving population having fled. 

62. Poland and clothing. After the battle of 
31st March, 1831, in which the Poles were victorious, 
they encamped in a morass, and remained there eight 
days. April 10th a part of this division fought 
before Siedlee with the corps of Count Phalen, 
which was infected with cholera. On the 13th, 
while passing through Kuflew, a report was received 
that six men had died of cholera after a few hours' 
illness. These men formed part of the first brigade, 
which had captured colors and several prisoners. 
Arriving near Minsk the cases became more numerous, 
and on the 15th fifty had died. The majority of the 
patients had on them clothing taken from the sick 
enemy. The second brigade, which had not been 
engaged at Siedlee, had no cholera for a length of 
time. Later, another division, in a state of perfect 
health, encamped near Kuflew, on the ground where 
the Russians had just been defeated; several bodies 
still lay exposed, others only half buried. Here 
cholera broke out anew among the Poles. Towards 
the end of May the division had a serious engage- 
ment at Tycocin, and cholera broke out among the 
Poles for a third time. 

63. About 200 tailors took as assistants from 
among the Russian prisoners, some of them to work. 



REMOTE CAUSE. 51 

Cholera immediately broke out among the former. 
Russian prisoners were dispersed over several vil- 
lages and towns, and wherever they went cholera 
coincided with their arrival. 

64. The last great battle fought by Count Die- 
bitsch was on the 26th of May, and the result was 
equivocal. Diebitsch took ill success to heart, was 
seized with cholera, at Pultusk, on the 10th of June, 
and in a few hours died. Also, on the 27th of the 
same month, the Grand Duke Constantiae died, at 
Witepsk, of cholera. 

65. Nijne-Xovgorod, in the centre of Russia, was 
attacked 27th of August, immediately after the great 
annual fair, when 100,000 merchants had assembled 
to purchase the shawls and furs that came from 
Orenburg, where these goods were stored over the 
previous winter, an infected place. But other 
writers say that cholera might have been brought 
by travelers from Saratof, where cholera raged fif- 
teen days before the fair. Both accounts are likely 
to be true. 

68. Enclosed plac3S escaped. The great city of 
Gourruckpoor and environs lost 30,000; but not one 
of the prisoners confined in the jails of the city 
was attacked. The frigate Topaz, from Calcutta, 
anchored in the port of St. Louis, Mauritius, Novem- 
ber, 1819, and had lost men and officers on the pas- 



52 ASIATIC CHOLERA. 

sage, but all were well on arrival at St. Louis. The 
haughty captain refused to obey the quarantine; he 
and his men went on shore, and soon after the pest 
broke out and spread rapidly — many were attacked 
while walking the streets, and died there almost as 
soon as attacked, so severe were the cases; 10,000 
are said to have perished; but the governor reported 
that the deaths did not exceed 7,000 or 8,000. Cer- 
tain habitations that interdicted all communication 
completely escaped. 

67. The neighboring island, Bourbon, in fearful 
proximity with Mauritius, became alarmed, and the 
governor, Baron Melius, at once established a laza- 
retto, lest it might be needed, and interdicted all 
communication from outside. This was effectual for 
a while; all escaped, until a smuggling vessel, the 
Pic-Var, clandestinely landed some runaway negroes, 
December 14th, at St. Denis, where the pest at once 
broke out. The governor immediately established a 
military cordon around the city, suffered no one to 
go out or go in. The attacked were sent to the 
lazaretto, which was also surrounded by military. 
By these means the country was saved from the 
spread of the pestilence. The contrast between the 
two islands was striking: Mauritius had 2n,000 cases, 
half of which died; Bourbon had only 259 cases, 
and 178 deaths. 



REMOTE CAUSE. 53 

Dr. Labrousse traced the infection step by step from 
the place where the Pic-Var landed the smuggled 
negroes into Bourbon first into two cottages, in 
one of which six negroes were attacked, and two in 
the other. The inhabitants, frightened, interdicted 
these places, and here the pest was arrested. At one 
of these houses, a negresse, Mamed6, wife of a fisher- 
man, infected her husband, and he died. She went to 
the residence of her master, a mile off; the next day 
she was attacked, and communicated the pest to a 
servant slave. The jail prisoners employed to con- 
vey the cases to the lazeretto died in the service, 
and only two nurses escaped. In the hospital the 
pest attacked not only the servants, but patients 
laboring already under other diseases. The doctor 
exclaims: " If this be not contagion, how comes it that 
a few sentinels effectually opposed its efforts to cross 
the military cordon ?" 

68. When cholera ascended the Volga the Mora- 
vian inhabitants of Serepta shut the gates and har- 
bors, suspended all communications with persons and 
things frbm outside, and thus excluded the pest and 
escaped. 

69. In Moscow cholera was arrested by seques- 
tering houses where it existed. 

70. In 1822 Mons. de Lesseps, French consul at 
Aleppo, fearful of the approach of cholera, shut him- 



54 ASIATIC CHOLERA. 

self up and his people, to the number of 200 persons, 
in a large garden not far from the city. The garden 
was surrounded by a wide fosse and a stonewall, 
with a gate at each end, which he kept guarded, and 
prevented egress and ingress. Not one person in 
this enclosed colony took the malady, while 4,000 
died in the city in eighteen days. 

71. In November, 1819, cholera attacked Sankerre- 
droog, and reigned there until the 14th December. 
But the mountaineers forbid any communication 
through the passes into the valley, by which precau- 
tion the pest was excluded and the inhabitants escaped 
its tyranny. 

72. The Pacha of Egypt adopted severe measures 
in July, 1824, and by them the disorder that pre- 
vailed in Syria was prevented from entering the 
valley of the Nile. This example, with that Qf the 
Shah of Persia at Teheran, proves, among many 
others, that the contagion can be arrested by exclu- 
sion. But at last, in 1830, news reached the pacha 
that a column of fugitive pilgrims had already passed 
Suez, and a second column had proceeded beyond 
Coffeir, the only points of communication with his 
dominions. Instant orders were sent to enforce 
quarantine in these places; but the early travelers 
had already passed, and by the 13th July 4,000 had 
arrived at Cairo. Cholera broke out first at Suez, 



REMOTE CAUSE. 55 

then at Coffeir, shortly after the arrival of the fugi- 
tives. Cairo next suffered. The physicians and 
apothecaries died; the board of health abandoned 
their useless efforts; people fled the city, and those 
who remained shut themselves up, and all these 
escaped. 

73. Caravans, infected, traversing from the south 
to the north, when nearing Teheran, the residence of 
the shah, alarmed him. He at once issued orders 
that the caravan should not approach the town. In 
consequence of this mandate, the caravan made a long 
detour, infecting as they went the places they passed 
through, but the city escaped by this precaution. 

74. Ships. The frigate Leander anchored, August, 
1820, in the port of Pondichery, where cholera raged. 
She soon became infected and put to sea to escape. 
On her voyage she lost ten men and two officers, 
before she reached the port of Trinchimalee, on the 
11th July, where no disease existed. Soon after her 
arrival cholera broke out among the persons and 
officials that communicated with the ship. The sur- 
geon of the Marine Hospital was the first victim. It 
soon spread through and through the island, pre- 
viously healthy. By coasting vessels it was carried 
across the strait into Colombo, January 10th 7 1819, 

75. A brig carried it to Astrachan, and by beats 
it reached the Sea of Azof, Sebastopol, etc. All the 



56 ASIATIC CHOLERA. 

fishing villages on the Arabian and Persian shores of 
the gulf escaped, while the great ship harbors and 
entrepots of commerce became immediately infected 
after the arrival of vessels from Bombay. 

76. The frigate Abercrombie left Bombay August 
10th, 1828, a diseased place, in splendid condition and 
fine weather. The same day cholera broke out on 
board. On the 12th the pest was general throughout 
the ship. Many men died in six hours. 

77. At Collapore the following occurrence is said 
to have taken place, no doubt much exaggerated. 
Sixty persons embarked to cross to the opposite shore, 
and only three were able to disembark, all the rest 
perished. 

78. The French frigates Cybele and Cl^opatre — 
the first put into Malacca and took in supplies for the 
crew on the 14th. On the 18th she put to sea. The 
fourth day out the disorder broke out on board, and 
resisted medical treatment. On the 22d January, 
1822, the C16opatre anchored in the roads of Manilla, 
where cholera existed fearfully. On the 30th the 
disorder broke out on board so severely that the cap- 
tain departed for Macao, and in eight days after no 
new cases occurred. 

79. Extreme cleanliness and hygiene made no differ- 
ence as a preventive or a mitigative of the pestilence, 
notwithstanding the clamor of ignorant busy-bodies 



REMOTE CAUSE. 57 

and meddlesome newspapers. Attend to these facts- 
In September, 1821, Shiraz became infected by com- 
merce from Bender Abassi. The harem of the prince - 
royal of Persia was almost the first arena of its fury. 
One of the first to succumb was one of his wives, besides 
several of the beauties in the seraglio, and some of 
his children. The palace of an Eastern prince is the 
embodiment of all the luxury and refinement that is 
in the power of man to acquire; grandeur, elegance 
and riches are the necessary accompaniments of the 
establishment; want, in the slightest degree, is un- 
known, and suffering, if any, can only rarely be felt, 
and that by the few ladies therein whose organization 
or moral sense may possibly here and there revolt at 
their servitude. Religion also comes in as a portion 
of the discipline, hygiene, and extravagance of the 
place; and, in this instance, is principally confined to 
frequent ablutions, extreme cleanliness, and a few 
easy prayers. The dresses are of the most costly and 
exquisite qualities, changed several times a day. To 
these habits all the attendants are scrupulously ob- 
servant. If here, where cleanlines and the most per- 
fect system of hygiene v that can be sought for exists, 
and still cholera invades such an abode, and rages as 
fearfully as among the most abject, poverty stricken 
and uncleanly people, why rail out against dirty 
streets as a cause, and neglect more important and 



58 ASIATIC CHOLERA. 

serious matters? The palaces and families of the In- 
dian princes, as at Delhi, etc., etc., escaped no more 
than the villages, unless it was due to exclusion. 

89. Religion as a prophylactic and a cure. Priests 
make a religion, indoctrinate the ignorant into a be- 
lief that they are the elect and preferred of the Deity 
to all outside of their fanaticism. This is the moral 
history of man, and flourishes in India. 

In 1818 the usual multitude of believers assembled 
at the festival of Jatra, in Punderpore. In a few 
days three thousand fell victims to both their faith 
and the cholera. These pilgrims, terrified at the pest, 
fled to their homes, in spite of their faith and the 
power of the priests; and wherever they went, there 
cholera broke out. 

81. Eastern superstition (religion of priests), in its 
severe and unrelenting precepts, scoffed at the power 
of cholera. The votaries, in obedience to the pre- 
cepts, assembled one hundred and twenty thousand 
to honor the shrine of Juggernaut — under the wheels 
of the car of the idol the most faithful annually took 
pleasure to prostrate themselves and be crushed to 
death — were waiting for the awful presence; but be- 
fore the priests could wheel it out of the temple and 
commence the sacred ceremonies, cholera, in contempt 
of the omnipotent symbol, broke out among the mul- 
titude, of which many thousands perished. The idol 



REMOTE CAUSE. 59 

remained in the temple incarcerated for several years — 
perhaps dared not to face the pestilence ! The vota- 
ries fled to their homes, undefended by an ungrateful 
deity, and spread the infection in their homes. 

82. When in June, 1827, the pest menaced Lahore, 
the people sought to arrest it by acts of devotion and 
charity. But Rungheet Sing, the Maraja, preferred 
to absent himself. He crossed the river Rari and 
encamped by the Kuttel-Khan gardens. By this 
course he preserved himself and his followers. 

83. In 1820 the King of Siam, alarmed by the 
irruption of cholera in his capital, convoked his sub- 
jects on the sea-shore, there, by religious ceremonies, 
to anathematize the disease. The result was appal- 
ling: seven thousand persons perished on the spot, 
and , with the arrival of fugitives into all the districts 
of the kingdom, cholera also appeared among the in- 
habitants. Forty thousand died in the capital, 
Bankok. Cholera treated the religion of the priests 
and the faithful with utter contempt. 

84. In the latter days of Chawl and the first of 
Zilcade (second week in May, 1831), thepilgrims ar- 
rived from Persia, the Indies, the Yemen, and other 
countries, suffering from the pest at the time of their 
departure. Crowded together, at Mecca, under 
every circumstance which could favor the propaga- 
tion of the malady — exposed to a broiling tempera- 



60 ASIATIC CHOLERA . 

tare, wallowing in the putrefying heaps of blood and 
offal of victims sacrificed at the feast Coram Bairam 
— in four days 20,009 individuals perished.* 

Many more instances might be cited, but the 
above are sufficiently disgusting. 

85. Range of Infection. In no case has the range 
of infection exceeded a few yards' distance, especially 
when the number of attacked is few, or the place is 
airy or windy, which blows the poison away into a 
dilution insufficiently concentrated to poison the un- 
affected. Cholera commenced in the eastern wing 
of the barracks, and proceeded therein westwardly 
through eight companies of the Fourteenth regiment; 
but it suddenly stopped at the ninth company, and 
the tenth or light infantry company escaped with a 

* Wallowing in putrefying heaps of blood and offal. This remark 
I suffered to be transcribed, that I might not alter the statement 
quoted— not that such putrefaction could engender or make 
cholera worse than if such filth did not exist. It has been abun- 
dantly proved by Bancroft, Parent du Chatelet, in their report 
to the Paris Council of Public Health, that workers in putrefying 
animal matters did not suffer from their disgusting trade. The 
butchers, glue-makers, catgut-string makers, knackers, anatomi- 
cal dissecting-rooms, etc., were not injurious. Orfila stated that 
the exhumed bodies, in a putrid state, kept several days under 
judicial examination, etc., never once disturbed the health of the 
operators. But a popular cry has been raised against dirt; of 
course, let it be suppressed, but not under a false accusation. 



REMOTE CAUSE. 61 

few cases only. There are many such events men- 
tioned as inexplicable; but it soon became known 
that all the time a strong westerly wind blew 
through the barrack, which was open and well venti- 
lated at the entrance end, to which end cholera did 
not reach; besides, a few yards' distance of separa- 
tion is abundantly proved to be a sufficient guaranty 
when communications are excluded, or at least well 
regulated. 

86. Length of time from exposure to the break-out 
of the infection is variable within a certain limit. It 
has seldom poisoned its victim in less than twelve 
hours after exposure; most commonly twenty-four 
to forty-eight hours, and rarely to the fourth day; 
but in the case of the French frigate Cybele (§78), 
four to five days intervened between the exposure 
and the irruption. 

87. Duration of the pestilence in each place. In 
a large and populous city, then, it would last from 
six to ten weeks, rarely to three months; among 
small communities and villages, it will have selected 
all its victims in a space of ten to fifteen days. This 
is easily explained ; for the free communication of 
the inhabitants of a small place, all known to each 
other, they soon have effected their intercourse with 
each other, while a much longer time must elapse 
in a large community before all can have com- 

4 



62 ASIATIC CHOLERA. 

mingled who are susceptible of receiving the 
poison. 

88. This is particularly remarkable on ship-board 
— a small, compact population. A ship puts to sea, 
apparently all well; in twenty-four hours, or a little 
oyer, one or two are attacked; by the third day 
nearly all the susceptible are down with the malady, 
and in a week more scarcely a new case happens. 
The dead are committed to the sea, and all hands re- 
main well for the remainder of the voyage, from four 
to six or eight weeks. But what happens after en- 
tering port? In twenty -four to forty-eight hours 
after, persons having intercourse with the passengers 
or vessel are attacked — even passengers who had 
escaped the first onset of the malady, now that they 
get into a new and healthy atmosphere, are attacked 
and die. This fact has been frequently noticed in 
Canada, where persons, after remaining many days 
in an infected city, have ventured to travel away 
and were attacked on their route, in the new atmo- 
sphere, and died. These instances are numerous. 
Nor is this peculiarity due to cholera alone. In the 
early transit of passengers across the Isthmuses of 
Panama and Nicaragua to California, many escaped 
the malignant ague of that climate, who, on arrival 
at San Francisco, a healthy place, where ague is un- 
known unless imported, in a few days are down with 



REMOTE CAUSE. 63 

ague; even those who have suffered on the route and 
recover were subject to a new attack in the new 
atmosphere. 

89. Conquest arrested. The victorious Abbas 
Mirza, fighting against the army of the Sultan, drove 
the Turkish army before him, battle after battle, until 
both armies reached Erzeroum, into which fortress the 
Turks betook themselves for safety, repose and resist- 
ance. But here a new and unconquerable foe appeared 
in the field. Cholera attacked the lines of Mirza, and 
turned his victorious troops and banners into impo- 
tence. His lines were smitten by an unseen enemy; 
his soldiers became frightened, threw down their 
arms, and fled in utter disorder — a real defeat ! 

The same thing would have happened to the army 
of the Marquis of Hastings, had not a most perfect 
discipline rescued it. As it was, the British columns 
in India have been retarded if not arrested in their 
operations more than once. The same thing happened 
to the Poles before Warsaw, and snatched victory 
from them. 

90. Drunkards. Although the Hindoos and Mus- 
sulmans are a temperate people, exceptions are met 
with, especially in the large towns, where drunkards 
are sufficiently numerous to attract attention. It was 
noticed that, after cholera had swept a city, the pro- 
portion of known drunkards that escaped all attack 



64 ASIATIC CHOLEBA. 

exceeded that of the well conducted people. In Can - 
ada, where the free use of liquor is common and 
cheap, for a while it was proclaimed generally, espe- 
cially from the pulpit and by magistrates, that the 
drunkards were carried off. 

I denied this at the time, but was remonstrated 
with on the ground that, even if I were correct, it 
was of great moral importance that the statement 
should go abroad. But in three months' time, the 
pestilence ended, all the old notorious drunkards re- 
appeared in public as heretofore. 

91. Bad crops and bad grain, as rice. Dr. Tyt- 
ler endeavored to show that bad rice produced chol- 
era; but this was at a time when cholera was raging, 
and no doubt many poor persons ate of bad rice. 
However, it is well known that after even a good 
meal of sound food, some unknown thing will cause 
an arrest or vitiation of digestion, followed by spon- 
taneous or sporadic cholera, resembling, in many of 
its symptoms, Asiatic cholera; but all those reported 
cases are defective in many points as regards cholera. 



CHAPTER III. 

COMMON SPORADIC CHOLERA MORBUS. 

92. Cholera morbus and cholera spasmodica, or 
Asiatic cholera, are two distinct states of the body. 
The first is a disease, the second is not. On account 
of this difference it is proper to mention at once the 
origin or etymology of the name. Cholera morbus 
has been in use since the time of Hippocrates, and is 
supposed by Celsus to be derived from xokr), bile, and 
'pew, to flow — literally, bile flux. It is so described 
by all systematic writers, who appear to copy from 
one another; all of them define the disease: bilious 
vomiting and purging, gastric pains, cramps in some 
cases, and prostration. It will not do for me to deny 
the accuracy of all authors since a thousand years 
past; but I am at liberty to say what I know, and to 
describe the cholera morbus I was called on to attend 
long before and since Asiatic cholera reached Canada. 

93. The cases of cholera morbus, now often called 
common cholera, that have come under my notice, 
were ^accompanied by bilious matter in the dis- 
charges. At first, when I was quite young in the profes- 



66 ASIATIC CHOLEEA. 

sion, I turned to authors in hopes of finding some excep- 
tional forms of the disease in which bile was not dis- 
charged; but I found all the books exact transcripts 
Of their predecessors, and was forced to come to the 
conclusion that I either mistook the disease, or had 
met w T ith one for which I could find no description. 
From year to year, until Asiatic cholera reached 
Canada, I was called to attend these nondescript 
cases, and often since. It is now time for me to de- 
scribe the " common cholera" I have in view, and as 
/saw it. The cases invariably occurred to persons 
in previous perfect health, adults of both sexes; 
scarcely ever in the winter months, but might be ex- 
pected in any warm summer night, more so when a 
thunder shower supervened to suddenly alter and 
cool the atmosphere. An individual, quite well, 
might eat a hearty supper with good taste and appe- 
tite, go to bed well, fall into a sound sleep of two or 
more hours' duration, and be awakened after midnight 
and before three in the morning with an uneasy feel- 
ing, nausea, quickly followed by vomiting and purg- 
ing. The first matter thrown up was the supper, ap- 
parently unaltered, after this there was a continuous 
watery vomiting; the first stool or two consisted of 
the accumulated feculent matter, after that the intes- 
tinal discharges were also watery, without odor and 
without colicky pains. The discharge from thQ 



COMMON SPORADIC CHOLERA MORBUS, 67 

stomach, was also without odor, or taste to the 
patient. In none of these discharges, either upward 
or downward, was there any bile, notwithstanding the 
convulsive vomiting which might be expected by its 
compression of the viscera, liver and gall blader, 
would be likely to emulge the bile into the stomach 
and intestines. In some cases cramps came on, the 
skin grew moist, and, in protracted cases, cold; in 
severe and protracted cases the voice failed a little; 
sanguineous stasis became apparent in the skin, but 
not to a degree amounting to the cyanosis seen in 
Asiatic cholera. The most prominent symptom was 
vomiting, the stomach being so sensitive as to be 
unable to endure more than a tablespoonful of fluid. 
It was this instability that made the difficulty to 
treat the case, for medicine in the form of draught 
was too voluminous to be retained long enough to 
calm the fretful state of the organ. On this account 
it was that the patient was directed to swallow, as 
best he could, a pill of one grain of pure opium, 
without any vehicle. If this could be retained for 
half an hour, it was sufficient to calm the stomach, 
arrest the discharges and cramps, if those happened 
to exist. It must be noticed that the patient is always 
very restless and tosses about the bed; so sure as this 
movement is permitt3d or indulged in, the opium pill 
will not remain on the stomach — vomiting will con- 



68 ASIATIC CHOLERA. 

tinue ; the most perfect quietude, even of speech, 
must be persevered in. One pill will generally arrest 
the great disturbance, and the patient will be well 
the next day, excepting the debility and the soreness 
of the abdominal muscles. When the case has been 
permitted to go on for a few hours, prostration 
becomes too great to be rallied from, the cold surface 
continues, sometimes with slight lividity of the skin 
and nails; the pulse becomes imperceptible at , the 
wrist, the heart acts feebly; consciousness remains 
clear from the first, at last becomes obtuse; restless- 
ness ceases, prostration increases, and the patient dies 
imperceptibly, without a pang or struggle. In some 
few of these severe, unarrested cases, the colliquation 
will cease, giving hope of recovery. The patient 
does so to some extent for a while, but the loss from 
the system has been too great; life has been too 
largely dissipated, and what little remains can only 
flicker, is insufficient to revivify what remains of the 
worn-out fabric. 

There is great thirst, of course, and it is useless to 
give the water called for, since it will be rejected as 
soon as down; but when the pill has had its effect, a 
spoonful at a time may be given, gradually increasing 
the quantity. 

91. I have never seen a case that occurred after 
sunrise. I do not remember one that was not pre- 



COMMON SPORADIC CHOLERA MOKBUS. 69 

ceded by perfect health, a hearty meal before bed- 
time, sound sleep, out of which the patient is awak- 
ened by the attack between 11 p.m. and 2 or 3 a.m., 
rarely before or after these hours. 

The foregoing description of what is now called 
common cholera, or cholera morbus, does not perfectly 
correspond with the disease so named in medical 
works. While I would not dare deny the correct- 
ness of the numerous authors who have classified and 
described the so-named disorder, I must say, for 
myself, that J have encountered none other than the 
form now imperfectly described. 

To illustrate the foregoing, and make myself more 
accurately understood, I shall give a few cases. 

95. 1st. That of Messire Beddard, a distinguished 
prelate of the Sulpician Seminary, in Montreal. He 
was taken ill, after his first sleep, in the night. The 
medical attendant of the house was called to his 
assistance, and prescribed as he saw fit. The violence 
of the attack was over in a few hours, although liquid 
dejections continued in small quantity for some time 
after. Hope, scarcely any doubt, was entertained of 
his recovery, after the storm had passed. But, 
although the discharges had ceased, he did not pro- 
gress in regaining strength. He rallied for a while, 
and again seemed less well. I was sent for about 40 
hours after the attack. I found him dressed in his 



70 ASIATIC CHOLERA. 

gown, standing in the middle of the room, surrounded 
by friends. He looked ghastly; with a husky voice 
lie requested acid drink, craved for clotted milk, du 
lait caille, above all other things. This his physician 
interdicted, and on this account I was called in. 
I approved of his taste, which I took to be an 
indication of what his stomach was capable of 
appropriating — a very grateful article of food, very 
digestible from the natural admixture of lactic acid 
with the curd, much consumed by the French Cana- 
dians. He ate some, with a little maple sugar and a 
few mouthfuls of bread; he wanted more, but was 
then restrained; it agreed well with the stomach; 
but he grew more and more feeble, became slightly 
delirious, and died some 50 hours after the attack, 
July 2d, 1825, aged 58 years. 

96. 2d. Cammeron, Dorchester street, a healthy 
and strong man, ate a moderate supper of stewed mut- 
ton and potatoes (left from dinner) at 8 p.m.; went 
to bed at 1 0, feeling quite well. He was awakened 
at the end of his first sleep by an uneasy but painless 
sensation. Vomiting came, first of the stew he had 
eaten, unaltered, next of a mawkish, watery fluid, 
repeated in gushes as fast as it accumulated; the 
parallel of this took place by the bowels, urged by 
violent abdominal contractions, but no colicky pain 
or bile could be detected. Pulse scarcely perceptible 






COMMON SPORADIC CHOLERA MORBUS. 71 

when I saw him at 2 a.m.; skin cold and clammy, 
some cramps in one leg, breathing easy and natural, 
with an occasional sighing respiration; voice much 
enfeebled; very restless. The first thing done was to 
deprive him of water, which he craved much, and 
rejected in gushes as soon as swallowed; the exertion 
of vomiting was a source of more exhaustion. From 
experience I well knew that a carrninitive draught, 
from its mere bulk, could not be retained. One grain 
of solid opium was got down, and by much persuasion 
and close watching he was kept from tossing about, 
since this alone would keep up the irritability of the 
stomach and the retching. In half an hour's time the 
retchings had diminished, the pill remained down, he 
grew easy. A little later he became dozy, and in an 
hour was allowed to take a spoonful of water at inter- 
vals, gradually increasing the quantity, as it was 
thought the stomach could bear. All the trouble sub- 
sided into a good sleep, out of which he awoke nearly 
well, with the exception of thirst, a few muscular 
pains, and weakness. In twenty-four hours he had 
quite recovered. 

Cammeron's case may be taken as a type of sporadic 
cholera that usually occurred in my practice in the 
hot summer months of Canada at Montreal; and the 
treatment I adopted was adopted by the very able 
and experienced Dr. Ariioldi, sen., and a few others. 



72 ASIATIC CHOLERA. 

I shall now give a third case, one in which no med- 
ical treatment was had recourse to until the malady 
had run its course and all discharges had ceased. 

97. 3d. Barth&emy 1'Espagnole, a native of 
Spain; a tall, lean, wiry man, about 60 years of age; 
he lived at the top of Sanguinette street, his house in 
a small garden, which he cultivated, and which sup- 
plied the wants of his wife and an only daughter; went 
to bed in perfect health on a Sunday night; was 
awakened with vomiting and purging, some cramps. 
He had no one else than his young daughter to send 
for assistance, through a long and lonely street, which 
he and his wife objected to. I saw him about 9 a.m., 
found him pulseless, cold, clammy, breathing easily, 
with an occasional deep drawn sigh; very thirsty. 
He had his senses, but was silent. This old man had 
very little substance to lose, was soon run out, and 
died. 

98. 4th. One more case, since to me it appeared 
very interesting. Mrs. Cowing had just recovered 
from typhus of nearly five weeks 7 duration. Her con- 
valescence was rapid, and, as is usual at such time, 
her appetite was extraordinary. On Sunday there 
was roast pork for dinner, of which she ate very 
heartily, and at 10 p.m., while in bed, she craved more, 
and was served with more. Her husband, a florid, 
robust and healthy man, ate also of the same pork at 



COMMON SPORADIC CHOLERA MORBUS. 73 

dinner, at 2 p.m. In the evening he took his tea, 
etc., as usual, feeling quite well; retired to bed at 10 
p.m.; about 2 a.m. he was awakened with vomiting, 
purging and cramps. The pork was the first matter 
rejected, unchanged, although it had remained in his 
stomach about twelve hours; all the other ingestahad 
digested. When I saw him he was nearly pulseless, 
cold and clammy; his florid cheeks were now slightly 
blue. Opium answered in his case like in those 
already described. His wife, who was only recover- 
ing from a protracted fever, did not experience the 
slightest disturbance from the same food that had 
acted so deleteriously on her husband. 

99. This case is interesting, as showing how food 
will prove nearly poisonous at times to one person 
and not to another, particularly as regards the woman, 
who was still in a state of great debility, but whose 
appetite was voracious; whatever is craved for will 
suit the stomach, in preference to that which is not. 
This is another example of what hypothesists seized 
hold of in arguing against cholera contagion. They 
said: " If contagious, how come it that I, who was 
exposed, did not take the disorder ?" And in like 
manner Mrs. Cowing might have said, " Why did not 
the pork serve me in the same way, if pork was the 
cause of my husband's trouble ?" 

Until 1817 cholera was unnoticed as being com- 



74 ASIATIC CHOLERA. 

municable. So was it in the sporadic cholera of 
Canada; but when the cases had become numerous, 
under what circumstances is unknown, it put on an 
additional character, which it has maintained ever 
since; and so it has ever been with every known con- 
tagion. 

100. Up to 1832 I had carefully read what was 
published of Indian cholera, and the fierce polemics 
on contagion and non-contagion. The printed de- 
scriptions of the cholera of India appeared to me to 
be exactly like the sporadic cholera of Canada, and I 
joined in the opinions of the non-contagionists. But 
how soon was I undeceived ! When I came to see 
the imported cases, while the symptoms appeared to 
differ only in degree, it was striking to the sight of 
the beholder of a case that there was a great differ- 
ence, but what difference tvords can not point out, 
more than a witness can define what difference there 
is between two countenances — each face possesses the 
same parts, eyes, nose, mouth, etc., etc., yet a witness 
can honestly swear to one person as positively differ- 
ing from another; and so can any one say from the 
first sight of a case of Asiatic cholera that it is not a 
case of common cholera. 

101. I have ventured to say, Sec. 92, that Asiatic 
cholera is not a disease. I have often so stated to 
medical men, to their astonishment and contradiction. 



COMMON SPORADIC CHOLERA MORBUS. 75 

After listening to a long, lame physiological and even 
metaphysical argument, I have asked one simple ques- 
tion : What is disease ? Until now I have not met 
with a single one of the ready argumentators who has 
been capable of answering the question. All writers 
and all remarks of medical men mention cholera as a 
disease, which expression I take to be an erroneous 
one when applied to this pestilence, and that it is a 
term which has warped the medical mind, by a mere 
word, into a vast variety of contradictory opinions, 
endless discussions, and absurd medication. It is 
accepted by the profession as a short and convenient 
way of designating the existence of something wrong, 
somewhere, in a part, or even iu the whole system; 
but it conveys no idea of what this something is. On 
this account I have ventured on the difficult and new 
task, that of giving a definition to a word heretofore 
bandied about loosely, meaning something, but what 
that thing is no one has stopped to inquire. My 
effort in this respect is a new one, no doubt very 
imperfect, but it is hoped will excite the abilities of 
more able physiologists than the writer has any pre- 
tension to be, and that hereafter the phrase " diseased 
action" will be less flippantly uttered. 

102. Disease is a disturbance in and among the 
molecules constituent of any tissue of the living body. 

The natural function of the molecular matter is 



76 ASIATIC CHOLERA. 

perturbated, but is not destroyed. Disease does not 
arrest their ivhole action, only modifies it for a while, 
until the disease becomes exhausted, and is followed 
by recovery, or is arrested by death. During a 
diseased state the molecules still functionate more or 
less perfectly, but functionation is not suspended. 
Innervation, nutrition, secretion, and absorption oc- 
cur; that is, new matter is formed, old structures are 
removed or greatly altered; deposits of fibrin or 
serum or pus, or new organizations, take place; this 
is disease. None of these characteristics of disease 
are met with in cholera. Examples of diseased 
action: 1. The sensorium is obscured or over-excited, 
but perception continues, is not suppressed. 2. The 
lungs may be variously perturbated, but still continue 
to functionate — take in oxygen and give out carbonic 
acid gas and vapor. 3. The stomach may not 
chymify completely, but still does so to some extent. 
4. The liver may be exceedingly disturbed, but the 
portal circulation is still carried on, and bile, such as 
it is, vitiated or otherwise, is secreted. 5. Kidneys 
may, like the liver, be much perturbated, greatly or 
slightly, but still eliminate more or less excrement 
from the body. 6. In inflammation the extreme 
vessels are perturbated, swell, even the structure con- 
taining them becomes infiltrated, but physiological 



COMMON SPORADIC CHOLERA MORBUS. 77 

action is not completely suspended. So on we might 
go through the whole catalogue of nosology. 

103. How different in cholera ! It alters suddenly 
all the physiological actions of the molecules it 
attacks, annihilates completely all function while its 
influence lasts. To illustrate the idea I entertain of 
the operation of the choleraic poison producing death 
without the intervention of " diseased action," I shall 
cite a few instances of death occurring in the complete 
absence of any possible disease. 1. A man falls from 
a height, is taken up apparently dead, and remains 
dead. In some of these cases, no bones are broken, no 
vessels ruptured, no apparent lesion can be detected; 
but he is dead: surely disease did not kill him. 2. One 
is shot through the heart and is instantly killed, before 
blood has had time to escape in any quantity to be 
accused as the cause of death; no disease acted here. 
3. A man descends into a fermenting vat; he dies 
instantly, without disease; but physiologists of the 
schools say something about the arrest of oxygen 
reaching the lungs, etc., but cholera refutes the doc- 
trine. 4. A drop of prussic acid put into the eye of a 
dog will kill instantly; here no disease has had time 
to be induced. So on we may go, citing numerous 
examples. 

104. If we contemplate with close attention various 
cases of cholera, we shall find numerous examples of 



78 ASIATIC CHOLERA. 

death taking place so suddenly that no possible disease 
had time to assist in the catastrophe. Some persons 
in perfect health have been stricken dead, it is reported, 
in fifteen minutes, even without discharges; but in all 
these sudden cases cyanosis was present. My case, 
cited Sec. 175, must have died very suddenly. If, on 
the other hand, we contemplate a less astounding 
case, we shall see that great numbers were severely 
attacked, and in twelve hours the colliquation had 
completed its work and left its victim well; nothing 
but weakness followed. Does disease act thus ? I 
cannot afford to extend this small book further, else 
I might cite a large volume in support of my assertion, 
Cholera is not a disease. Reader ! do not believe me, 
but learn for yourself, as I have done. The delusions 
created by education are delightful; so that, few 
things are more painful to the deluded than an attack 
upon, or a refutation of, their fond and long cherished 
errors. 

105. It may be asked by some one: what good can 
a verbal distinction make ? 1. In reply, I say the 
difference is not in words but in facts, as has been 
clearly shown; a wrong name leads to a misconcep- 
tion of the thing named. 2. The practitioner who 
calls cholera a disease will carry into practice his 
habits of treating disease where none exists, and work 
up for his guidance the idea of an imaginary pathol- 



common sporadic cholera morbus. 79 

ogy and a physiology which cholera utterly refutes. 
Out of this error in a name the wildest notions of 
medication have been adopted, useless, in all cases, 
injurious in nearly all, and horribly cruel to the 
patient in many, as shall fully appear in the chapter 
on Treatment. 



CHAPTER IV. 

SYMPTOMS EXAMINED IN DETAIL. 

Invasion of a patient. In all cases of cholera the 
symptoms, or, rather the phenomena, are exactly the 
same ; they differ only in degree. In some slight 
attacks they do not all appear to take place, or rather 
are less noticeable; and in some rare cases the victim 
is at once prostrated and killed in a few minutes — he 
is overcome, and cannot seek or call for assistance, 
and dies where he happens to be. Such cases are 
reported, by respectable authority, to have ended in 
death in fifteen minutes. 

106. The invasion is very variable as regards 
admonition or not; some have no previous warning, 
but the majority have. A gentleman, in the habit of 
taking a ride before breakfast, mounted his horse as 
usual, feeling in perfect health. He had not gone far 
when an uneasy feeling came over him; he sickened, 
and was conveyed back to his house; vomited copi- 
ously many times, purged the same without the 
slightest colic pains; his skin became clammy, wet, 
cold and cyanosed; had a few cramps in the legs; had 



SYMPTOMS EXAMINED IN DETAIL. 81 

taken brandy and opium; and by evening, a period of 
twelve hours, the colliquation had completely ceased; 
he slept well, and next morning had quite recovered, 
with the exception of being weak and thirsty. 

107. The governor of Madras, Sir Thomas Munro, 
sat down to breakfast in perfect health, but was sud- 
denly interrupted in his repast, being overcome in an 
indescribable way; he grew cold, skin clammy; said 
to his aide-de-camp, " I am an infected man, and shall 
die." He did die in ten hours. Men on sentinel duty, 
men at guard-mounting, who rose in the morning in 
perfect health, ate breakfast as usual, and marched 
with their accustomed smartness to the parade, were, 
without the least premonition, attacked and pros- 
trated; men in their usual health were suddenly 
stricken while marching; mounted men, unconscious 
of any thing wrong in them, were suddenly dis- 
mounted. These cases were numerous, public, and 
officially reported. The same came under my own 
observation, as the case mentioned, Sec. 175 ; that of 
the soldier on a visit to his fresh arrived friends on 
the night of the 9th to 10th June; that of the old 
man's wife at Contrecour, and one or two in the 
Chesser family, 

108. But the majority of cases had suffered a period 
of incubation after exposure, during which incubation, 
seldom reaching to four days, they remained perfectly 



82 ASIATIC CHOLERA. 

well, when at last the attack would occur as suddenly 
as in all other cases. This interval of time suggested 
the idea that the poison had to grow to a sufficient 
amount, or sufficient virulence, before it could over- 
come the natural healthy action carried on in the 
patient; when it arrived at that point the attack 
became manifest as in every other case, sudden, more 
or less violent, perhaps in conformity with the tem- 
perament of the victim. 

109. A regular attack takes place with an in- 
variable set of symptoms of more or less severity, 
preceded, in some cases, by an uneasy feeling of not 
being quite right. The patient is soon prostrated; a 
cold perspiration, or rather transudation, breaks out 
over the whole body and limbs, which quickly assume 
a leaden color, may deepen to blue, or even to brown, 
according to the natural tint of the patient. The 
fingers, toes, arms and legs quickly diminish in size; 
the skin is wrinkled, shriveled, especially that of the 
fingers, which are reduced in thickness one-third of 
their previous size; the superficial veins are easily 
seen as dark, or nearly black, lines; the temperature 
is rapidly reduced beloiv that of a dead subject; the 
patient all the time complains of feeling hot. In all 
this " cold stage/' as it has been called by a supposed 
analogy to fevers, there is never the slightest shiver- 
ing, chattering of the teeth or trembling that is met 



SYMPTOMS EXAMINED IN DETAIL. 83 

with in the cold stage of ague; on the contrary, the 
patient invariably complains of heat , wants exposure, 
and will not suffer covering, excepting of the lightest 
kind. The pulse soon becomes imperceptible at the 
wrist, and in a short time it cannot be felt as high 
up as the axilla, but what pulse can be felt is scarcely 
quickened in number; on listening, the heart is still 
heard acting feebly. Vomiting soon succeeds, and 
purging, by gushes, in astonishing quantity, of a cold, 
grayish-white fluid, resembling thin gruel, or " rice 
water," devoid of odor or taste (to the patient), and 
without colic; cramps, in the legs mostly, less fre- 
quently and severe in the arms, occur. The abdomi- 
nal muscles also are cramped; but the cramp pain is 
less severe here than in the legs; the " bellies" of the 
muscles appear prominent between the tendinous in- 
tersections; the whole belly is drawn in. Inspiration 
is disturbed only slightly, in some few cases a little 
quickened, in all is voluntary; deep inspiration can 
largely expand the chest, and a long drawn sigh every 
now and then takes place, to end in a peculiar hollow 
moan. The expired air is quite cold, so is the mouth 
and tongue. The voice is peculiar and sepulchral in 
tone, approaching to aphonia. The eyes are deeply 
set in their orbits, and quite dry; no tears are pro- 
duced even during the deep anxiety and anguish of 
friends and relatives present. The countenance be- 



84 ASIATIC CHOLERA. 

comes more cadaverous and ghastly than by death 
under any other form of disease. 

Great restlessness prevails while the patient has 
strength to toss about on his bed; he lies mostly on 
his sides, curled up, until near death, when he may 
settle on his back. His mind is clear to the very 
last; he knows all that is passing, but is taciturn and 
speaks only in answer to questions. His perceptions 
are all natural, excepting that of external sensation, 
which he complains of as being hot, while he is 
cadaverously cold, and cannot bear the weight of 
covering. He complains of intense thirst, and in- 
cessantly calls for water, cold water, which is no 
sooner swallowed than is rejected with a gush. 
Urine is totally suppressed; but there is a constant 
desire, in the male, to void it. At last the patient 
becomes seemingly insensible — he is dying; but never 
is there heard a throat rattle; he dies quietly, without 
a pang or struggle. 

A severe case, like that which is just described, 
generally dies in twelve, sometimes in eight, six, or 
even less hours. 

110. Some such cases seem to have run and com- 
pleted their course in eight to twelve hours; the in- 
fection or cataclysm appears to have exhausted itself, 
leaving the patient prostrated, with no apparent re- 
mains of the complaint, excepting the persistence of 



SYMPTOMS EXAMINED IN DETAIL. 85 

the dark color of the surface, but which gradually 
diminishes with the return of the circulation and the 
resumption of the pulmonary function of aeration, 
both of which had been completely arrested during 
the cyanosed state. Such a patient loses his restless- 
ness and resumes his voice to some extent, gives 
hopes to his friends; but too often it happens that life 
only struggles on for a day or two more, when he 
sinks forever. Some of these cases resist death a 
while longer, and put on that peculiar state of the 
system said by many writers to be the " typhoid stage;" 
but this, on careful observation, presents nothing to 
justify such a name. This apparent fever is simply 
an effort to rid the system of a portion of the poison 
that remained after the undescribable evacuations 
had ceased and not carried all off, and is also an effort 
of nature at recovery. 

Ill, A less severe form, but still of the collapse 
kind, is often met with, excepting of less severity and 
duration. Many of these cases are soon over; the 
discharges by the skin, stomach and bowels being 
very free; cyanosis is less deep, cramps less severe, 
emaciation less, breathing about the same, and 
aphonia; the expired air, tongue and surface are 
cold; pulse extinct at the wrist; urine suppressed, 
etc. Such a patient may be seen up and about the 
next day; he is only weak, easily tired, and much re- 
5 



86 ASIATIC CHOLERA. 

duced in weight and plumpness; lie is well. In this 
case it would appear that the poison, whatever it 
may be, was quickly all carried off by the discharges, 
or it had quite expended its force. 

112. In the mild cases, cold and wet skin and 
cold tongue constitute part of the attack. The circu- 
lation is not completely arrested, hence cyanosis is 
absent, or nearly so; there may be some vomiting 
and purging, but no cramps, and the voice is scarcely 
altered; urine is not totally suppressed, but passed in 
small quantity only. Such cases may last longer 
than the second form. The prostration and loss of 
substance is slight. It would appear that in this last 
form the poison had made only a slight impression on 
the system, and is eliminated slowly. 

113. Cholarine, a name given to a diarrhoea that is 
often met with some days after the great onset and 
force of an invasion has, to a considerable extent, 
exhausted itself. This name was invented by Parisian 
practitioners to distinguish such cases from real 
cholera. It is rarely met with in the first days or 
week of an invasion. The stools are feculent in 
appearance and odor, are liquid, brown, not fre- 
quent, and in small quantity, unaccompanied with 
colic, or only so in a slight degree. I have often 
considered these cases and had good reason to believe 
that many of them were clue to mental anxiety acting 



SYMPTOMS EXAMINED IN DETAIL. 87 

on the bowels. This diarrhoea is easily controlled 
by a judicious use of opium, reasonable diet, and an 
assurance given to the patient that he is not affected 
with cholera; in this way the patients nearly all 
recover. But a certain number of real attacks are 
preceded by this derangement of the bowels, which, 
I feel confident, is not a part or necessary forerunner 
of an attack. Why should not cholera supervene on 
such a diarrhoea, when we see cholera attack persons 
laboring under acute diseases, as fever, typhus fever, 
even small-pox ? 

114. Between the three degrees of cholera men- 
tioned there are many shades of intensity, from that 
of an astounding attack that kills, without previous 
warning, and without discharges, in fifteen minutes 
or even less time; cases of great and sudden collapse; 
and cases in which there is only a simple uneasy feeling 
with moderate discharges. Hundreds have died before 
the cholera cause, the immediate cause, has had time 
to colliquesce the tissues into the particular and 
peculiar fluid which, being oozed into the stomach 
and bowels, excites the vomiting and purging usually 
met with, and also its transmission through the skin. 
In these astounding cases death has taken place in a 
few minutes' time in persons who have previously 
made no complaint of feeling ill. Marvelous as this 
statement may seem to the inexperienced, it is cor- 



88 ASIATIC CHOLERA. 

roborated by nearly all the writers on cholera in 
India, who, being military officers, and their patients 
of the same class, their opportunities for exact obser- 
vation are greater than those of civil practitioners, 
who have to rely on the vague statements furnished 
by people in a state of confused excitement. 

115. At the risk of being accused of repetition, the ■ 
writer may be permitted to refer once more to what 
has already been said: " At Bundlecund, in the army 
of the M. of Hastings, the invasion was so sudden and 
violent that mounted men were stricken from their 
steeds, fell and died on the road; .... sentinels, 
after guard mounting and placed on their posts, were 
suddenly overcome, and quickly died." Such is only 
one of the official reports; the same has occurred 
again and again on numerous occasions in India, at 
Malta, and even in Montreal, as shall be referred 
to hereafter. 

Let us now proceed to contemplate or examine the 
symptoms, or rather phenomena, that occur in this 
dire pestilence. It is difficult to decide on which 
function we should first inquire into, since they all 
depend on each other in the warm blooded vertebrate, 
i. e. the nervous, the sanguineous, and the aerative or 
pulmonary systems; besides, also, they often seem to 
be all attacked simultaneously. 



SYMPTOMS EXAMINED IN DETAIL. 89 

116. What is understood by the word symptom, as 
met with in nosological authors, does not occur in 
cholera, excepting after the disorder has run its course, 
without death, and an effort is made by nature, as it 
is said, to restore the system to health; then comes 
that quasi fever, which has been supposed to resemble 
typhus, and is erroneously called by that name. 

117. The first symptom, or nervous one. A general 
uneasiness is felt — "I am unwell/ 7 But this even is 
not always mentioned by the patient, for some died 
without making this premonitory remark. When the 
invasion of the malady is well under way, innervation 
is perverted in one respect only — the patient com- 
plains of heat, while he is as cold as a corpse; he 
objects to be covered, wants the bed clothing removed, 
the weight of which annoys him; a great restlessness 
prevails; he tosses or moves about on his bed; during 
all this time, and to the last, his intellect is undis- 
turbed, and remains clear to the last moment that it 
can be manifested. 

118. The pulmonary system, or aeration. Inspira- 
tion and expiration take place, to all appearance, as 
usual, excepting that there is occasionally a deep 
inspiration, followed by a similar expiration, resem- 
bling a sigh, and ending with something like a slight 
groan. The expired air, on striking the hand or face 
of the practitioner while examining the patient, feels 



90 ASIATIC CHOLERA. 

like a cold blast — as cold as the atmosphere. It comes 
out of the lungs unaltered in temperature; and during 
the collapsed or cyanosed state, even when this lasts 
for several hours, its chemical constituents remain 
unaltered, or nearly so; the lungs have taken nothing 
from it, have given nothing back; that is, oxygen has 
not been absorbed, nor carbonic acid returned in 
exchange. 

119. Circulation, and, the blood. From the earliest 
examination of a choleraic patient the pulse will not be 
found much altered in time; but it is smaller and 
softer than usual, which alteration becomes more 
marked as the case progresses; gradually, it ceases 
to be perceptible at the wrist, next in the course of 
the humeral artery, and lastly in the axilla. It now 
becomes evident that the heart is incapable of sending 
the diminished column of blood on which it acts to 
the extremities of the arteries. Although the heart 
contracts and dilates with regularity, it does so like 
the heart of a frog or turtle, or other low animal, from 
an inherent power proper to it, independently, to a 
great extent, of the blood that enters it. There is a 
mere flux and reflux of blood from and to the ven- 
tricles — a mere remora of blood in motion. The 
column of blood is not driven to the extremities of 
the arteries and returned by the veins; in a word, 
circulation has ceased, and still the patient lives for 



SYMPTOMS EXAMINED IN DETAIL. 91 

some hours. His intellect remains unclouded to the 
last, in spite of theories that insist on the necessity of 
a full supply of arterial blood to the brain to support 
its function. Here we find two great functions 
essential to life in a well person arrested, or at least 
too much crippled, to supply the wants of the system 
they were created to uphold; and the absence of 
which, in any other condition of the economy than 
during cholera, results in speedy death. But in 
cholera the system seems to b£ indifferent to the sup- 
pression of these two great functions, and to the arrest 
of physiological actions, the integrity of which has, 
until now, been deemed essential to a living warm 
blooded animal. 

The red globules of the blood cease to be acted on 
in the lungs, arterialized and crimsoned, and carbon 
given off; hence the leaden color of the body, and the 
stasis of the blood in the capillary system of the 
tissues. 

120. Digestion is completely annihilated; conse- 
quently neither chyme nor chyle are produced, and 
no supply enters the circulation; besides, as circula- 
tion is arrested, no secretions can take place; hence 
it is that no urine is produced ; that ulcers, acute or 
chronic (like the varicose) at once dry up; that the 
most virulent and copious clap at once ceases (to be 



92 ASIATIC CHOLERA. 

resumed when cholera has run its course and the 
patient has recovered). 

121. Calorification. Red blood, that is, blood con- 
taining red globules, is found in all vertebrate 
animals; in very small quantity in fishes, and more 
and more of it as we ascend in the scale towards 
warm blooded animals. In the lowest and lower 
grades, red blood is of no use to the animal, and 
appears to be one of rudimentary development in 
creation anticipatory #f a higher future structure 
and want, not needed in the lower animals. 

Many facts go to prove that it is the red globules 
that receive in the lungs the material creative of 
caloric, which, by these globules, is distributed to all 
parts of the body. In cholera it is self-evident that 
the globules undergo no change in the lungs; but, if 
they did, the effect of the change would amount to 
little, since the circulation of the blood is arrested, 
and these globules cannot be carried to the extremi- 
ties of the vessels. To this peculiar condition of the 
blood and the arrest of circulation is the reduced 
temperature of the body greatly due ; but not 
altogether, for the quick lowering of the temperature 
of the body of a choleraic patient is apparent in less 
time than could take place from a mere reduction of 
the temperature of the blood, and the long time a 
deficient circulation takes to permit a whole body to 






SYMPTOMS EXAMINED IN DETAIL. 93 

cool down to the ambient temperature. A choleraic 
patient becomes as colft as a subject dead several 
hours, or even colder, and that shortly after the 
attack; he cools down while alive more rapidly than 
does a body which had died of even a lingering 
disease, or one that has been killed. 

122. Cold. This condition of a choleraic patient is 
no doubt due, in some degree, to the dark state of the 
blood; in other words, to deficient aeration of the red 
globules, and the diminished force with which the 
blood, as such, reaches the extreme arteries. In cases 
of arrested development of the heart, like in puer 
coeruleus, the temperature of the individual is always 
less than in those where perfect aeration takes place; 
and such persons, when exposed, quickly lose the 
little heat they possess. Another cause for reduced 
temperature is met with in paralysis. But both 
these examples do not illustrate or explain the rapid 
loss of caloric in a choleraic attack. The diminished 
or complete arrest of the circulation, even that of 
black blood, does not explain why, in cholera, the 
body is so soon cooled as it is. If this were due to 
the diminished circulation of even black blood, the 
length of time the circuit takes to be accomplished, 
and the number of times this circuit must be repeated 
before all the blood completes the round, requires 
more time to reduce the temperature by this means 
5* 



94 ASIATIC CHOLERA. 

than it takes cholera to accomplish the task. A 
choleraic patient becomes cold in much less time than 
it takes a dead body, from any other cause, to cool to 
the same degree. Besides that, a body after ordinary 
death never sinks below the temperature of the 
atmosphere and the ambient bodies; on the contrary, 
a choleraic patient, lying in an atmosphere of 88° to 
90°, is soon cooled down to less than 70 Q or 68°. His 
body is not only colder than the temperature of the 
room he is in, but the interior of his body is equally 
cold. This extraordinary fact is proved by his 
expiration being as cold as the air he inhaled; but 
his stools are still colder, and they come from the 
interior of his bowels. 

123- During the cholera invasion of 1832, in 
Canada, I mentioned this fact to several practitioners, 
who seemed not to have noticed it, and affected not 
to credit my remark. It so happened that I was 
called to visit Mr. Horace Dickenson, aged 45, on the 
21st of August, 1832, a wealthy gentleman, living in 
a fine house, situated in a very healthy locality. He 
had been suddenly attacked, was already in the 
cyanosed state, and purging still continued when I 
saw him. His family physician, Dr. Robertson, sat 
on the side of his bed, and was in the act of passing 
napkins under him to catch the evacuations that came 
by gushes. One poured over his hands; he lopked 



i 



SYMPTOMS EXAMINED IN DETAIL 95 

round at me with an air of astonishment, and ex- 
claimed, " You are right; his stools are quite cold !" 
We spoke of this occurrence afterward. He said: 
"I did not quite credit your statement when you 
made it, some days ago; but now I am convinced of 
the reality." He went on to remark: "How could 
such large, gushing quantities of cold stools come out 
of a warm body ?" This is only one instance of how 
superficially many practitioners examine and reflect 
on their cases. The body was not only cold outside, 
but cold throughout the viscera. A very little reflec- 
tion would have drawn attention to this unusual sub- 
ject, from the fact of a cold tongue, a temperature 
that could not well be less than that of the head or 
mouth that contained it; also, had attention been 
paid to the cold breath of a patient, in contrast to a 
warm breath breathed out in the coldest days of a 
Canadian winter, while in cholera, even in the hot 
summer days, say 88° to 90°, it is much below that of 
the inhaled atmosphere. 

124. Where did this expired air meet with its 
reduced temperature, if not in the lungs; and if there, 
how could the lungs be colder than the rest of the 
interior of the body ? These are only two instances 
indicative of the interior coldness of a living body 
of a choleraic patient. . 



96 ASIATIC CHOLERA. 

125. A warm enema is soon returned cold, as has 
been noticed by others besides myself. 

126. But now I must adduce a third, and an irre- 
fragable proof of interior coldness, however start- 
ling the statement may prove to the readers of this 
sketch. To those who are unacquainted with the 
deep and perfect religious faith of the French Can- 
adians in Lower Canada, all Catholics, what follows 
may possibly appear extraordinary, and perhaps 
censurable; but to a reasonable and generous minded 
man all religions are respectable, and should never be 
trifled with. Well, baptism is there esteemed es- 
sential to salvation, and to an inheritance of the king- 
dom of heaven. Many pregnant women, attacked 
with cholera — and, as repeatedly said before, the 
intellect of the patient remains unclouded to the last 
— many of these women, conscious of the certainty of 
their death, urgently begged that a Caesarean operation 
should be performed, in order to save their fruit and 
give to it the benefit of salvation by " infant baptism." 
Several practitioners yielded to these entreaties and 
operated. I was present at a few such operations. 
Although I never once operated, I took advantage of 
the inevitable opportunity to pass my hand into the 
living abdomen among the intestines. In every case 
that I did so, the viscera felt quite cold. To prevent 
any doubt from being entertained on this point, I will 



SYMPTOMS EXAMINED IN DETAIL. 97 

give the names of some of the operators. The first on 
my list is my respectable and able colleague at the 
time, Dr. Pierre de Beaubien, resident physician, then 
in charge of the cholera hospitals, one of the most 
assiduous and pains-taking practitioners, at his post 
before six o'clock in the morning, and who, by his 
thorough anatomical knowledge and numerous care- 
fully conducted autopsies, was able to throw much 
negative light on the pathology of cholera. Dr. 
Beaubien is still a practitioner in Montreal, and prin- 
cipal physician to the Hotel Dieu Hospital there. He, 
I believe, operated three times. Dr. John Stephenson 
(the first person operated on for staphyloraphy, by 
M. Roux, in Paris) operated on two. Dr. Munro, at 
present physician, along with Dr. Beaubien, at the 
Hotel Dieu Hospital, operated about ten times, as well 
as I can ascertain. Dr. Robertson operated on one; 
Dr. Valine operated on six, to my own knowledge, 
besides others. As the medical gentleman I have 
named were, and are, of the first respectability in 
Montreal, honorable and conscientious in their prac- 
tice, which was public, and their doing necessarily 
made known to my office of Health Commissioner, I 
have felt it to be no breach of confidence, but a duty, 
to name them while writing on cholera. 

127. On the 27th of Oct., 1865, 1 had a conversa- 
tion with Dr. Beaubien on this subject. He mentioned 



98 ASIATIC CHOLERA. 

that the foetus was dead in every case he operated on, 
unless it might be one in which Dr. Munro assisted 
him, who thought he did see some slight indication of 
a movement, but that he, Dr. Beaubien, had doubts of 
the fact. We can easily conceive the existence of a 
passive movement occurring to a foetus in removing it 
from its folded up position in the uterus; and I may 
add, without offering the slightest offense to Dr. 
Munro, that he was at that time a young man, and 
very zealous, conditions that might lead to error, in 
the hope of success. 

In justice to Dr. Beaubien I must state that he told 
me his Cesarean operations took place in the shed 
hospital, on women who had just expired, or about to 
expire; but that he had not operated on a woman 
actually alive. In a letter I have from Dr. Munro, he 
mentions having operated in all thirteen times, not 
all of them cholera cases, women on whom he was in 
attendance for the purpose of operating, and waited 
to nearly the last moment of life before operating. 
As to interior temperature he has no recollection, 
never having given it a thought. 

The practice of Dr. Valine was principally confined 
to the suburbs, among the laboring classes. Finding 
that many of the Cesarean operations were performed 
too late, he was easily prevailed upon to operate 
while the patient still lived. It was in some of his 



SYMPTOMS EXAMINED IN DETAIL. 99 

cases I attended, at his and Madam Tavarnier's re- 
quest, that I had the opportunity of passing my hand 
into the live abdomen, noticing the interior coldness 
of the viscera and that of the foetus. In these cases 
the funis was simply divided, and no search made for 
the placenta, and no blood was discharged. 

128. On more than one occasion I made use of a 
u physician's thermometer;" inserted it into the rectum. 
I also got Madam Tavarnier, a celebrated midwife in 
Montreal, to pass it into the vagina of some of the 
patients, especially into that of some of the females 
operated on by Dr. Vallee, at all of whose operations 
she assisted. She carefully noted the temperature, 
and made her report to me. At present I cannot give 
a copy of her report, which was lost, along with many 
of my notes, during the political troubles of 1837, etc.; 
but I remember well that the temperature indicated 
by the thermometer in vagina was lower than that of 
the atmosphere at the time, during some of the hot 
days of July and August. 

These operations will be noticed again when treat- 
ing of a few other curious, interesting and important 
facts connected with this remarkable and still obscure 
malady. 

129. In cases of saline injections, which were at a 
temperature never less than 110°, at times 112°, even 
120°, and of which injections a portion oozed into the 



100 ASIATIC CHOLERA. 

intestines and came away in gushes, these discharges 
were cold; therefore, the injection must have lost its 
high temperature in passing through the interior of 
the body. 

I trust I have adduced sufficient proof that the 
interior of the body is cold, while the patient is still 
living, in cases of cholera. 

130. Vox cholerica, or partial aphonia. After 
much reflection on this symptom I have been unable 
to arrive at any satisfactory explanation. To com- 
mence with the least satisfactory of my thoughts on 
the subject, a mere idea, was, how far the empty or 
contracted state of the innominata and the aorta could 
disturb the action of the recurrents, seeing that they 
wind round these vessels, which, in health, are per- 
manently distended. I well remember the case of a 
would-be suicide who cut his throat, and the left re- 
current, and who lived a few years after. His voice 
was weak and rough, and to produce it strong expira- 
tion was necessary; but still, in his case, the voice 
heard was not quite that noticed in cholera. The 
next, and more reasonable explanation, might be 
attributed to the altered state of the lungs, and the 
quality of the expired air. Another and more likely 
reason might be found in the deposition of some of the 
choleraic, pultaceous matter in the larynx and about 
the vocal cords; for it was not uncommon to find this 



SYMPTOMS EXAMINED IN DETAIL. 101 

matter deposited in small quantity in the trachea. 
These are mere ideas, only speculative, so that little, 
if any, reliance can be placed upon them* 

131. Perverted sensation of heat on the surface and 
in the stomach is constantly present in every case, 
while, in every other respect, all other sensations, 
as hearing, sight, smell and taste are natural, with an 
undisturbed intellect. This cannot be explained by 
any known physiological theory, or even by the 
wildest speculations of would-be physiologists. We 
must remain satisfied with the fact, and not presume 
to explain that which is not given to us to know. 

132. Cramps. Can the cold state of the patient, 
and the vacuity or uselessness of the arterial system, 
be related to their production ? It is well known 
that many persons past thirty years of age will be 
seized with cramp in a foot or leg when lying down, 
and cold at the time. Another well known fact is, 
that after great and rapid loss of blood, or other 
quick drain from the body, cramps are not uncom- 
mon. No doubt there is some other influence in their 
production than these now mentioned. A few writers 
on Asiatic cholera state cramps as pathognomonic, 
even in slight cases. But there are many cases 
wherein this symptom has been absent, and they do 
not occur in children. 

133. Urine, suppression of. It is easy to account 



102 ASIATIC CHOLERA. 

for this symptom. Vomiting, purging and transuda- 
tion have completely drained the system, and what- 
ever fluid may have been taken in is almost as soon 
rejected, and none remains long enough in the stom- 
ach to be absorbed into the circulation to fill up the 
deficiency, even if absorption could take place in the 
cyanosed state of cholera; the arterial system is 
empty and cannot be replenished for the reasons just 
stated; besides, it is doubtful whether the impulse of 
the heart can drive the little vitiated blood within its 
power as far as to the extremities of the emulgent ar- 
teries; if this do not take place urine cannot be gener- 
ated. It is generally said that secretion is derived 
from the blood; but this is a loose assertion, repeated 
by routinists, who seem not to be aware that the ar- 
teries are common carriers of blood and the fluids 
poured into them by the process of ingestion; but it 
is not from the blood, as such, that the materials of 
secretions are derived; it is had from the heteroge- 
neous materials added to it. This is not the place 
to discuss these facts, which I have exposed many 
years since. Since there is neither material to fur- 
nish secretion, nor circulation to carry the material 
to the secretive organ, none can take place, and, of 
course, the bladder remains empty. 

134. It is stated that urea is found in the blood; 
there is nothing remarkable in this, that a compound 



SYMPTOMS EXAMINED IN DETAIL. 103 

element should be found in small quantity in the 
blood that remains, since it is unknown in what way 
the choleraic poison affects the chemical components 
of the tissues and fluids, and might spare this ele- 
ment, while by its mutation of ordinary compound 
elements into others of a different quality, only dif- 
ferently grouped, without losing or gaining a simple 
atom. One or two analyists have said that the quan- 
tity is great; no doubt, if it be spared at all, being 
found in blood greatly diminished in volume, the 
quantity would be disproportioned and appear large. 
Some persons may make this objection — since cholera 
permits the complete escape of the salts of the blood, 
why not urea also ? The salts that do escape are 
mineral, while urea is a created body out of organic, 
not mineral, matter. 

135. Strangury, as it is often called in these cases 
of ischuria, is almost a constant occurrence in male 
patients, a ceaseless but ineffectual desire to urinate; 
and I have known a busybody practitioner introduce 
a catheter to draw off what urine he supposed was in 
the bladder; of course, he found none. For nearly the 
three or four first weeks' continuation of cholera, I 
was unable to imagine what was the cause of this 
distressing symptom. At last I unexpectedly dis- 
covered it, a most simple one, which I shall now 
describe. It is easy to get a good view of the pelvis 



104 ASIATIC CHOLERA. 

in a cholera subject, since the intestines are all 
empty, and take up but little space. They can be 
lifted or moved out of the pelvis; this affords a good 
view of the urinary bladder. But, first, there are 
those who suppose that in the operation of discharg- 
ing the bladder it contracts in all directions down to 
almost complete vacuity. This is an error that 
lithotomists ought to know, even those practitioners 
who frequently draw off the urine with a catheter. 
Now, the base of the bladder lies against the floor of 
the pelvis, between the back of the pubis and the 
front of the rectum, in the male, where it is tied down 
to this floor, and is never removed thence, however 
much the viscus may be distended with urine; here it 
forms a fiat , adherent disc, about two or two and a 
half inches in diameter, from side to side, and from 
before backwards between the pubis and rectum; in 
t he very centre of this disc the urethra opens. When 
t he bladder expands by accumulation of urine, it is 
the sides and summit that expand, and a portion of 
the base also stretches to some extent, but the base 
never leaves its attachment to the floor of the pelvis, 
to which it is affixed by pretty close cellular tissue. 
When the bladder is empty all contracts, the summit 
and sides as far as to the lateral limits of the base 
disc, and in this state the summit of the bladder 
forms another disc, of equal dimensions to the base 



SYMPTOMS EXAMINED IN DETAIL. 105 

one, and comes into immediate flat contact with the 
lower one. If, now, the intestines be pushed away, 
on looking into the pelvis, this summit will come into 
distinct view, with a depression in the centre, like an 
umbilicus, corresponding to the internal meatus that 
perforates the base disc. Let the anatomist, with a 
curved scissors, cut into the bladder all around the 
point of meeting of the two discs so as to separate 
them, and by taking the edge of the upper disc with 
a forceps gently pull it away from the lower one; 
he will find that the umbilicated depression is pro- 
duced by a portion of the summit being forced into 
the meatus, acting in the latter like a foreign body, 
and creating the sensation of micturition. If this 
dissection be well conducted, on taking hold of one 
limb of the upper disc, and gradually drawing it 
away, it will be noticed that some little force is re- 
quisite to draw the invaginated portion out of the 
meatus. The complaint of incessant desire to 
urinate is most noticeable in those cases that have 
been accompanied with violent vomiting and abdomi- 
nal contractions, along with gastric cramps, for it is 
these compressions that force the viscera against the 
summit of the bladder and press its centre into the 
meatus. 

136. Females escape this accident, by reason of 
the different mode of attachment of the bladder, a 



106 ASIATIC CHOLERA, 

considerable portion of which lies against the anterior 
surface of the uterus and anterior face of the vagina. 

I trust I have not uselessly wearied the patience of 
the reader in this long detail; for I confess that, 
until I discovered this fact, I had not a very accurate 
notion of the extent of the attachment of the bladder, 
although I had often dissected these parts, and had 
many times performed lithotomy. 

137. Transpiration. The discharge through the 
skin, could it all be collected, would amount to 
many pounds. It commences almost at the onset 
of the attack, and is always as cold as the sur- 
rounding atmosphere; in a hot summer day of 90° 
it is colder than the atmosphere and the furniture of 
the room. Most writers on cholera use the word 
" perspiration ;" but perspiration, like secretion, has 
no existence during an attack of cholera. The dis- 
charge through the skin is not brought to this exten- 
sive organ by the extreme arteries for the impulse 
of the heart does not reach so far; all is stagnation. 

To account for this great oozing through the skin, 
as well as that which is poured into the alimen- 
tary canal, both fluids being of the same quality, 
search must be directed elsewhere than to the vas- 
cular system, the operation of which is arrested in 
cholera. Writers on cholera say that these fluids 
consist of the serous parts of the blood, the red 



SYMPTOMS EXAMINED IN DETAIL 107 

globules and part of the fibrin being left; but this 
does not explain the whole loss, nor how this serous 
fluid reached the surfaces to pass out, for neither the 
absorbents, the veins or arteries act; nor does the 
assertion (for it is merely an assertion) demonstrate 
that the " rice water 77 matter consists of serum, as 
such, and of fibrin, to which two bodies it has not the 
slightest resemblance; nor can organic chemistry 
prove any thing beyond the simple fact that it is 
animal matter, reducible by analysis to C. H. O.N, 
in special proportions, besides containing a few salts 
that are always present in the blood, and the tissues 
outside of the blood. 

It is possessed of peculiar properties that are not 
found in any known secretions derived from' the tor- 
rent of the circulation. It freely arrives at the 
cutaneous and intestinal surfaces and permeates them 
to escape from the system; but it never passes through 
the serous membranes, since none is ever found in the 
peritoneal, pleural, or arachnoid cavities. None is 
ever met with in the urinary or gall bladders, but 
some is occasionally found in the bronchi in small 
quantity. Whence, then, does this peculiar fluid 
come, and from what is it produced ? are important 
questions. 

1*38. Catalysis is the only theory which, to me, 
appears capable of rendering an explanation. The 



108 ASIATIC CHOLERA. 

cholera poison, whatever it may be, and however it 
may enter the body, soon acts on the juices combined 
with the tissues, and which, by a simple mutation of 
the numerical proportions that constitute the com- 
pound elements which make up the different elements 
of the body, creates another set of compound elements 
which is fluid, and has the property of freely passing 
through the tissues to reach the outward surfaces and 
escape, dispensing with the services of the absorbent 
and arterial systems. 

139. Bile. The gall bladder is always distended 
with natural looking bile, in every case, and the duc- 
tus communis choledocus and the ductus hapaticas are 
both perfectly open and unobstructed in their whole 
length. How the bile remains in its bladder and is 
not forced out into the duodenum and pumped into 
the stomach by the violent vomiting of the patient, 
and the strong contractions of the abdominal walls 
compressing the cyst, baffles explanation; for, in 
ordinary vomiting, bile is always, towards the last, 
forced more or less into the stomach; while in chol- 
era an invariable characteristic is that, during the 
whole duration of the attack, no bile is ever dis- 
charged, none even after the acute stage has termi- 
nated and a return towards health has commenced. 

However, the presence of bile in the gall bladder 
after arterial action has mostly ceased, need cause no 



SYMPTOMS EXAMINED IN DETAIL. 109 

surprise, since bile is the product of the splanchnic 
veins, and the liver, like many other portions of the 
system, continues to act after animal death. But 
that which remains unexplained is, how is it re- 
tained ? 

140. Leaden color, blue or cyanosed skin, appears 
simple enough. A portion of the venous black blood, 
and, perhaps, a little furnished by the non-aerated 
arterial blood is not returned to the great vessels and 
heart, but lies stagnant in the rete malpigM of the 
skin, also among the vessels, and gives a very dark 
color to the abdominal viscera, as is seen in Csesarean 
section, and which, seen in the abdomen, some wri- 
ters have called congestion, a convenient word; but 
whether the blood, so stagnant, consists of globules 
escaped through the parieties of the vessels as whole 
globules, or is hsematin, separated from broken up 
globules, is not yet clearly known. 

141. In rapid- cases, such as recover in twenty- 
four hours or less, the blue color almost as soon dis- 
appears, or nearly so; but, in cases that linger 
logger, the skin remains dark for several days, the 
blue color gradually changing to a dirty red, less and 
less so daily. However, some of the dusky red tint 
will be perceptible as late as the tenth day, as I saw 
in the case of a very fair skinned lady, who then died^ 

6 



110 ASIATIC CHOLERA. 

exhausted, in that state which has been erroneously 
called typhoid. 

1-12. Mental faculties. During the whole of this 
wonderful commotion in the economy it is exceedingly 
interesting to notice that the mental faculties suffer 
only one aberration — an erroneous sensation of heat, 
while all is preternaturally cold; in all other respects 
the judgment remains perfectly sound and unclouded, 
so much so that the remark has been made within my 
hearing in regard to a weak minded or trivial person 
while healthy, that such an one has now sober senses 
for the first time. 

Routine physiologists insist that the manifesta- 
tions of mind from the brain require a full supply 
of healthy arterial blood; but in cholera the blood 
sent to the brain is disordered blood, and the quantity 
passing through it, like all over else, is much dimin- 
ished. Verily, this disorder contests many opinions 
that have been handed down as true and promulgated 
as essential to animal existence. 

113. Thirst. This is not due to fever, to inflam- 
mation, or to an excessive amount of salt in the blood, 
as a meal of salted food will excite the salt blood, 
calling for dilution ; not due to fever, for there never 
is any; nor is it like the thirst that follows rapid loss 
of blood, and which is a voice calling for repletion. 
The cholera thirst quickly follows, almost precedes, 



SYMPTOMS EXAMINED IN DETAIL. 11 

the first evacuations, lasts until the attack has ceased, 
even during the " typhoid state," for several days, 
growing less and less urgent as the system becomes 
replenished. It is the most urgent, constant and dis- 
tressing symptom; the craving for water, cold water, 
is incessant, and is no sooner drank than it is thrown 
up again, and more is called for; so irritable is the 
stomach, it does not remain long enough to be ab- 
sorbed, even if absorption existed, which is not the 
case in the cyanosed state. This thirst is due to the 
great and rapid loss of fluid the system has suffered, 
and the craving is more the voice of nature than that 
of the patient, ever crying aloud, I am empty, fill me; 
and the cry will continue until the depleted system is 
restored to its usual state. 

We have now come to the end of the critical 
examinations of the phenomena ever present in 
cholera— -it is hoped not without exciting some in- 
terest in the reader. 



CHAPTER V. 

ITINERARY IN CANADA. 

Departure of cholera from Great Britain, its ar- 
rival in Canada being the introduction of a new pest 
into a new country. At the close of Chapter I. it 
was said, " we shall trace it, led, as it were, by the 
hand, across the ocean into the New World." 

144. By direction from the Colonial Office, Lon- 
don, the Governor, Lord Aylmer, sent a message to 
the House of Assembly, February 3d, 1832, recom- 
mending that a bill should be passed for quarantine 
and health purposes. About the 25th, the bill was 
reported and passed. It was the first sanitary and 
quarantine measure ever enacted in Canada. It em- 
powered the Governor to name a Board of Health, to 
consist of senior magistrates, a Health Commissioner, 
a Eesident Physician, establish a quarantine station 
at Grosse Isle, below Quebec. This act possessed two 
great merits: 1st, it was short; 2d, the Governor was 
to make the appointments, and could, of course, dis- 
place his appointees at pleasure. 



ITINERARY IN CANADA. 113 

145. Grosse Isle was an excellent station, an 
island, that could not be reached without permission, 
and had safe ports and good anchorage. Here he 
established a military post, with officers to command, 
and a small battery to enforce obedience to passing 
vessels; the Resident Physician on the island to at- 
tend to the sick; and the Health Commissioner was 
executive officer. Dr. Griffin, surgeon of the 23d regi- 
ment, was appointed to the latter office; being a mili- 
tary man, he was habituated to system, method and 
obedience, and to enforce the same. But his office 
was a new one, created in a hurry, and not well 
organized for some time. He took possession of his 
post on April 23d, only ten days before the merchant 
fleet came rushing in, this year later than usual. On 
the 1st May snow fell and covered the country " in 
the white robes of winter." 

146. A similar Board of Health was created for 
the cities of Quebec and Montreal. The civil magis- 
trates put on these boards were relied upon by the 
public as gentlemen of character and honor, and not 
place-holders. They simply gave countenance to the 
Executive of the Board, and never introduced im- 
pertinent interference in any district. Quebec was 
not quite as well off as Montreal, because the great 
importing merchants and consignees of vessels could 
exercise some unseen control, while Montreal escaped 



114 ASIATIC CHOLERA. 

this, seeing that vessels which arrived here had 
passed through all necessary supervision. 

147. Shipping from Great Britain endeavors to 
leave towards the end of March, so as to pass into 
the gulf and up the St. Lawrence before the descend- 
ing ice accumulates to bar their passage. In 1831, 
the first arrivals at Quebec were as early as April 
24th; but in 1832 this fleet was caught in the ice of 
the gulf April 20th, and some of the vessels choked 
therein for fifteen to eighteen days before working 
through; the first did not reach Grosse Isle before 
the 3d May. Let us stop here for a few moments to 
notice the departures of vessels from the ports of 
Great Britain and Ireland, infected places. 

148. The Robert, from Cork, now at Grosse Isle, 
14th May, a few days out, with passengers, had 10 
deaths, the last one on the 23d April. Seven of the 
ten died of common cholera; three of Asiatic cholera. 

Constantia, from Limerick, 28th April, 170 emi- 
grants, lost 29 in fifteen days; 3 of Asiatic cholera, 
11 common cholera, the rest diarrhoea. 

Elizabeth, from Dublin, May 28th, 200 emigrants, 
lost 22; 2 of Asiatic cholera, 11 common cholera, and 
5 of diarrhoea, a few days out. 

Carrick, from Dublin, arrived at Grosse Isle June 
3d; lost 42 in the first fifteen days out; all well on 
arrival. 



ITINERARY IN CANADA. 115 

Brig Brutus, from Cork, 270 emigrants, in a few 
days had many deaths; after that all well. 

Ship Brutus, from Liverpool, 18th May, 3B0 pas- 
sengers, mostly people from the agricultural districts. 
On the 28th, in the morning, all were well. In the 
afternoon had one man and one child attacked, and 
died. On Tuesday death made fearful ravages. On 
Saturday threw 13 overboard. On Monday the 
mate, steward and cook teok ill. Captain made for 
Cork, but went into Liverpool. Total deaths since 
cholera broke out, 81. The foregoing are not 
selected instances of cholera breaking out on ship- 
board shortly after sailing for Canada, but were 
taken promiscuously from among many. It will at 
once strike the reader how similar are these facts to 
those already mentioned as attacking the British 
shipping in India, and the two French frigates after 
leaving Manilla. The reader will not fail to notice 
the glaring attempt at deception practiced by the 
captains on the quarantine authorities; such as, "the 
Elizabeth lost 22, only two of which were of Asiatic, 
and 11 were of common cholera, and 5 of diarrhoea" 
— nothing is said of the remaining 4. Where did the 
veracious captain acquire his great diagnostic knowl- 
edge between Asiatic and common cholera ? 

The Carrick, from Dublin, lost 42 in the first fifteen 



116 ASIATIC CHOLEKA, 

days; after that all was well, until arrived at Grosse 
Isle, June 3d, when one woman was attacked. 

The brig and the ship Brutus each speaks in the 
same way for itself. 

The Elizabeth lost 22, of which 2 were of Asiatic 
and 11 of common cholera: what a knowing captain! 
But we have all heard of " sea " invoices being made 
by captains of vessels to suit emergencies. 

149. It was said that " we shall trace cholera from 
England, the leap-off point in Europe, across the 
ocean into Canada." It is hoped that the shipping 
cases, just referred to, will suffice to establish that 
point. And that they will confirm what was said, 
Sec. 88, that on ship-board cholera would attack the 
crew and passengers in a short time, as early as 
twenty-four hours after leaving port, seldom later; 
and by the third or fourth day nearly all on board 
susceptible of the pestilence would be down with the 
malady; that by the end of ten days, or two weeks 
at most, scarcely a new case would happen. But when 
the ship would reach her destination, and her people 
get on shore, some who had escaped while on board 
might, in a new atmosphere, be attacked; and the 
well passenger would infect some of those they ap- 
proached, as was the case at Mauritius. 

Quarantine station of Grosse Isle received ships 
from British infected ports early in May, some of which 



ITINERARY IN CANADA. 117 

vessels had had cholera shortly after leaving the 
infected port, and the pest was soon over on board. 
These vessels reached the quarantine all well. They 
were, however, detained for a few days, the passengers 
sent on shore, they and the vessel well cleansed and 
thoroughly aired, after which they were permitted to 
go to the end of the voyage, Quebec. 

150. It is curious to observe that the pest did not 
appear in Quebec, the first stopping place, for the 
space of an entire month, although several hundred 
ships moored there, and many thousand passengers 
had debarked. The first appearance of cholera took 
place Friday, the 8th June, as was made public by the 
Quebec Mercury of Saturday, the 9th. * Since yester- 
day morning eight cases have occurred and three 
deaths, and two others despaired of. This disease first 
appeared in a boarding house in Champlain street, a 
narrow street between the base of the cape and the 
port, kept by Roach. The patients are emigrants, and 
said to be some of those landed on Thursday evening 
from the steamer Voyageur. 3 p.m. Fifteen cases 
have appeared since yesterday morning, seven of whom 
have died." 

151. This account is defective, in not stating where 
the Voyageur picked up her passengers; but as there 
was no intermediate place between Quebec and Grosse 
Isle where any passengers could be had, we are forced 

6* 



118 ASIATIC CHOLERA. 

to suppose that she got them at Grosse Isle, either 
openly or clandestinely. The dates of the arrival of 
the Carrick at quarantine on the 3d, and the out- 
break in Chaniplain street on the 8th, are sufficiently 
precise to fix the importation of the pestilence on the 
Carrick. 

All the newspapers that pander to the merchants 
for support at once railed out against the Mercury 
for creating "unnecessary" alarm. One paper said: 
" The Mercury is censurable for spreading such a re- 
port, creating an alarm that must affect commerce over 
the continent of America, and will prevent the summer 
influx of pleasure seekers from the U. S., who spend 4?, 
large sums of money in our cities." In consequence 
of the alarm so excited Dr. Morin, Health Commis- 
sioner at Quebec, and T. A. Young, Esq., Secretary of 
the Board of Health, went down to Grosse Isle to 
ascertain all the particulars respecting the crew and 
passengers of the Carrick. They made the follow- 
ing report: 

152. "Board of Health, Quebec, June 8, 1832. 
Various reports having been circulated that a vessel 
had arrived at Grosse Isle in which there were several 
persons ill of Asiatic cholera, public notice is hereby 
given that the Health Commissioner, having pro- 
ceeded to Grosse Island, by order of the Board of 
Health, has reported that the brig Carrick, James 



ITINERARY IN CANADA. 119 

Hudson, master, from Dublin, arrived at quarantine 
on the 3d instant; that there were on board 133 
passengers, all of whom had been landed, and are in 
the Emigrant Shed; that the vessel is undergoing the 
usual process of disinfection; and that at the time of 
his departure, on the evening of the 7th, there was 
not a case of Asiatic cholera on the island. By order 
of the Board of Health. T. A. Young, Secretary." 

153. This proclamation from the Board of Health 
is so studiously obscure that it excited doubts regard- 
ing the honesty of the signers, and increased the pre- 
vailing alarm instead of quieting it. It was in con- 
sequence of rumors of the existence of cholera that 
the Commissioner went to Grosse Isle, returned and 
made this ambiguous report, but not a word is said 
of what actually existed in the city ! In a day or two 
more the pestilence had spread so widely that disguise 
could no longer be maintained, and, as a substitute, 
the cry was spread, " Cholera is not contagious, it is 
merely in the air, etc. Let not the people be alarmed; 
attend to business as usual; live frugally and tem- 
perately; observe great cleanliness. It is only the 
reckless, intemperate and drunkards that suffer." 
Abominable falsehoods like this were daily repeated 
for a while, and even announced from the pulpit, 
notwithstanding it was notorious that the affluent 
and most respectable members of society died daily. 



120 ASIATIC CHOLERA. 

Members of Parliament, magistrates, wealthy retired 
gentlemen, living in their own sumptuous houses, on 
their own property, in select places as to salubrity, 
were attacked and died as early as the poor and the 
profligate, and in a statistical proportion greater than 
that of the poor. Still the would-be moralizers and 
teachers of society did not perceive that they were all 
this time calumniating the character of the best men, 
even their friends, who filled the highest stations. 

154. The first cases of cholera that broke out in 
Canada happened in an emigrant house kept by the 
man Roach, on the noon of June the 8th, among 
passengers brought there by the steamer Voyageur. 
This same steamer carried a load of emigrants from 
Quebec to Montreal, and arrived at the latter place 
late in the afternoon of the 9th. At once the pas- 
sengers crowded upon the wharf with their trunks 
and baggage. They managed to get away in a short 
time to the entrance of the Lachine Canal, in the 
Ste. Anne suburbs. When the wharf became clear of 
the incumbrance, a man was seen lying on his back, 
dying. I happened to be passing at that moment, 
and took a look at him. I had him carted to the 
Roman Catholic dead-house. Here he was seen by four 
other medical men, one of whom, Dr. T. Arnoldi, 
opened a vein, and by much squeezing and kneading 
of the arm about a tablespoonful of very black 



ITINERARY IN CANADA. 121 

thick, cold blood was obtained. He soon died. We 
never could ascertain who he was. 

155. Among the departed was an Irish family. 
They took lodgings in the upper room of a neat, 
clean and small hotel near the port. A soldier in the 
garrison was related to them; he got leave to spend 
the night with these his people. About 8 a.m., Sun- 
day, the 10th June, I was sent for. I found a woman 
and a man of those arrived the preceding evening 
dead, and the soldier blue and dying. He was at 
once removed to the garrison, and was the first case 
of death from cholera that occurred there. This 
statement is remarkable in several points : 1st, the 
steamer that carried the first cases of cholera to 
Quebec was the same pest ship that brought these 
cases to Montreal and landed the dying man on the 
wharf; 2d, while there is nothing unusual for cholera 
to break out among persons who had gone through 
previous exposure, but who, on reaching a new 
atmosphere (Sec. 149) should be attacked, there is, 
3d, the sudden and astounding invasion of a healthy, 
vigorous man, the soldier, that had never been 
exposed before, and who was attacked and died in 
about 12 hours. 4th. The time from the outbreak in 
Quebec to that in Montreal was barely thirty hours. 
5th. The distance between Quebec and Montreal is 
about 200 miles, and over this long distance, thickly 



122 ASIATIC CHOLERA, 

inhabited on both shores of the St. Lawrence, cholera 
made a single leap, without infecting a single village 
or a single house between the two cities— the houses 
all along the distance not over one to two acres 
apart. Theorists said that cholera traveled in the 
air — was not given out by the patient. In such a 
case as this the air must have been very capricious. 

156. On my return to breakfast after visiting the 
patients in the hotel, a messenger was waiting for 
me to go to a man in Sanguinette street, St. Lawrence 
suburbs. There I found an old laboring man lying 
at the point of death, his bed, as usual, among the 
French Canadians, surrounded by women kneeling, 
repeating the litany for the dying. He was blue, 
cold, and soon died. He went to bed quite well; was 
awakened about midnight, with vomiting and purg- 
ing. On leaving this house I was met by a mes- 
senger, who requested me to go to St. Constant 
street. Here I found another man, like the last one, 
dying of cholera, and, as usual, surrounded by neigh- 
bors, praying and repeating the litany. Both these 
men had spent the day previous at work on the beach, 
and had joined with the curious to look at the dying 
emigrant lying on the wharf. During this Sunday 
many other cases broke out. 

157. At this time, 1832, there scarcely existed 
such a place as a " tenement house" in Montreal. 



ITINERARY IN CANADA. 123 

Each French Canadian had his own house, small, 
neat, clean and comfortable, with at least a yard, and 
often a small garden. They were all acquainted 
with each other, and mostly intermarried. From this 
close relationship a death could scarcely occur that 
the moribund was not surrounded by relatives and 
neighbors, praying. A happy people, living on 
little, but a sufficiency, and contented. This kind 
habit of attending to the dying exposed those who 
assisted to the contagion, and they carried it into 
their own families. Hence, if nothing else conspired, 
abundant means for the spread of the pest was 
established. It is, therefore, not surprising that by 
Tuesday morning, the 12th, there were accumulated 
in the Roman Catholic burying ground, St. Antoine 
suburbs, over 100 unburied; fame said 200. This 
excited great clamor — some one must be blamed — 
this fell on the Health Commissioner. I imme- 
diately prepared to burn all above ground; this made 
a still greater clamor; I was remonstrated with by 
busybodies on behalf of the suburbs, people who 
feared that the smoke would spread the pestilence. 
My reply was : dig graves, if you want the bodies 
buried — that is not my office; if graves are not fur- 
nished I shall burn. The gentlemen of the seminary 
addressed the people at the church door, and these 
turned out and dug trenches, 10 feet wide, 8 deep, 



124 ASIATIC CHOLERA. 

over 100 long. The dead were closely packed there 
in tiers three to four deep, and covered over with 
earth, leaving the remainder of a trench to receive 
new comers. Several such trenches were filled from 
first to last, and many respectable persons, incapable 
of getting a private grave, were herein buried. It 
was different in the Protestant grave-yards — the 
number of deaths being much less than among the 
Catholics, as the latter made up the majority of the 
population. 

158. I must now return to the Voyageur, a pesti- 
lent steamer, owned by speculators, whose morality 
lay in profit. As this vessel carried her live cargo 
from Quebec to Montreal without stopping on the 
way, no one between thje two cities was infected. It 
was said that she threw overboard several dead on 
the passage, but I was unable to establish the truth 
of the accusation. However, I discovered the follow- 
ing fact : after passing Sorel about a mile a feather 
bed was thrown overboard, and floated down the 
river; a man named Latour, a small farmer, and 
occasionally a small meat butcher, saw the object. 
He paddled out in his canoe, picked up the bed, took 
it to his house at the point of the Island St. Ignace, 
and began to dry it. This man took cholera and 
died in 12 hours; his wife also took the pest and 
died. An old man and his wife lived on their little 



ITINERARY IK CANADA. 125 

property a mile above the village of Contrecceur, 
where the river is several miles wide. He was out 
in his canoe fishing, when a raft came slowly floating 
along with the current. The captain of the raft 
spoke the old man and requested him to take one of 
his men, dead, ashore, and bury him on the beach. 
The old man had not heard of cholera, and took the 
body ashore and buried it; this was on Saturday 
afternoon. During the night the old man took ill 
and died; his wife also sickened, and on Sunday 
morning the passing neighbors, seeing the house 
shut, mentioned the fact to his nephew at the parish 
church. The nephew went to his uncle's house, 
found the old man dead, and the woman about to 
expire. After doing his duty to them he returned to 
his home, a farm in the " Second Range." He took 
ill and died, but the intermediate people escaped. 
A drover, French Canadian, left Sorel, then slightly 
infected (and never much), to go to the Eastern 
townships; on his way he had to pass through a 
dense, primitive and uninhabited forest, seven miles 
across, in the centre of which there was one of the 
little wayside taverns, the only house; here he halted 
about midnight, took some refreshment, and in an 
hour or two set out to complete his journey. The 
next day the innkeeper was attacked, and after him 
his wife; both died. If these are not cases of con- 



126 ASIATIC CHOLERA, 

tagion, what else can they be ? I will add one more 
case, taken from an American paper : " Oneida 
Castle, July 23d : The captain of a passing boat 
hired an Indian to bury a man from on board. 
The Indian was immediately after seized, and died; 
five other Indians were also attacked; all of them 
died." 

159. All the above are cases of attack produced 
by immediate intercourse with infected persons, at a 
time when such a pestilence as Asiatic cholera was 
unknown, and had never before existed in the 
country. All sudden attacks, breaking out within 
12 hours after exposure, and all of them astounding 
and ending in death; all among people who lived, 
each in his own house, comfortably and healthy. 

160. A city newspaper, of June 16th, says: " Busi- 
ness seems paralyzed. Physicians and ministers in 
vehicles ply with velocity day and night through all 
parts of the city and suburbs; druggists and apothe- 
caries keep their shops open all night, On Friday 
morning the carts again appeared in the streets, 
bearing two or more coffins each, some with lids 
unfastened, and some corpses without coffins." This 
was true. As regards coffins, I set carpenters to 
work to make them out of rude boards. I had 
several depots of these coarse boxes, and furnished 
them on application, by a ticket, to all those who 



ITINERARY IN CANADA. 127 

called for one; among the number were many re- 
spectable persons who could pay for decent coffins, 
but none could be had other than those I furnished; 
they, therefore, called at the office for them. I 
remember one poor Irish woman who had lost her 
husband and could not call or send for a coffin; she put 
her husband, doubled up, into a chest, hailed a passing 
cart, and in this way sent the corpse to the public 
trenches. It was no unusual thing for a carter of the 
dead to call out, on passing a house, have you any 
one to send to the burial ground ? In this way he 
would get from two to four at a load, and call on me 
for his pay. 

These remarks may appear irrelevant; but I give 
them to show how dreadful the mortality was for the 
first two weeks. There were a few wealthy persons 
who procured a better style of coffin for themselves. 

161. Leaving the appalling throng of cases occur- 
ring among the lower and a higher class of sufferers, 
I shall now notice what occurred among the upper 
class, who were all well off. On the 15th, only five 
days after the outbreak, the Seignior Saveuse de 
Beaujeu was attacked and died in about twelve hours. 
He lived in his own house, a fine one, in a healthy 
street, with his daughter and two old servants; the 
rest of his family he sent to his seigniory, where they 
escaped. Tuesday, June 26th, Miss Hervieux, a 



128 ASIATIC CHOLERA. 

young lady, called to keep her friend, Miss de 
Beaujeu, company. She was taken ill in the even- 
ing, about 10 o'clock, full dressed; but feeling much 
restraint from the presence of two or three young 
gentlemen, night-watchers, remained dressed, sitting 
in an arm-chair; she died about daylight, the 27th. 
At once a coffin was ordered, a passing cart called, 
and immediately sent off to the burial ground, her 
family not knowing what had occurred. I mention 
this case since it created much extravagant talk then, 
and which took some years to subside; also because 
it was affirmed that she was buried alive, in the dress 
she died in, and her jewelry on her. To confirm the 
statement of her being alive, it was stated that she 
moved, or twitched, on being put into the coffin. This 
case, if true, is the only one noticed in Montreal of a 
choleraic corpse moving after death, as was men- 
tioned in European journals to have occurred. 

162. On the 15th, in the night, died, at one of the 
cholera dispensaries, Grant Struthers, a medical stu- 
dent, and next day Dr. Smith, and Pierre Delorme, a 
rich man. Benjamin Thatcher, who left in the even- 
ing to go to Yermont to escape the pest, died on 
the road in the morning. On Monday, Campbell 
Sweeney, Esq., and Mrs. Try; the latter was left alone 
in her room with her servants. Her house was situa- 
ted in the centre of a large orchard, at a distance 



ITINERARY IK CANADA. 129 

from other houses, spacious, airy and luxurious. 20th, 
Harry McKenzie, Esq., N. W, Company, rich, inhab- 
ited his own fine house; Stephen Sewell, Esq., Solici- 
tor-General. A young lawyer, Levi Adams, recently 
married, lived in a new house, all of the furniture of 
which was new, in a remarkably healthy locality, St. 
E. Xavier street, adjoining the seminary garden — he 
died; the next day his wife and the servant girl died 
< — a whole family blotted out in two days. Horace 
Dickenson, wealthy, in an airy house, only a few 
hours ill. June 21st, Jean Bouthillier, Esq., Sen., 
and his daughter, Mrs. Panet; Pierre Beaudry, Esq., 
and his son, living in a large orchard, dry, healthy, 
and very wealthy, both died; my much esteemed and 
wealthy friend, Benjamin Beaubien, Esq., attorney; 
John Flemming, Esq., President of the Montreal 
Bank; Miss Moffatt, aged 15, daughter of Geo* Mof- 
fatt, Esq*, the largest importing merchant in the city; 
Mary Coton, of Tamworth, England. On the 7th 
August, Thomas Gibb, merchant, and many others. 
26th, Rev. Newglove, at the residence of Wm, Lunn, 
Esq.; residence wealthy, beautiful and salubrious. 
These few, out of a great number of cases I might 
cite, will suffice to show that cholera spared not the 
affluent more than the lower orders; and as regards 
intemperance, there could be no greater libel uttered 
than even to hint at such a vice existing among peo- 



130 ASIATIC CHOLERA. 

pie of their rank and respectability. If a statistic 
of all the cases were taken, it would show that the 
proportion of deaths among the wealthy and well 
conducted people was proportionately greater than 
among the lower orders; and as to cleanliness, the 
habitations of the suburbs people, of course not opu- 
lent, were cleanly, comfortable, and well supplied 
with wholesome living, in a degree and quantity suf- 
ficient for the wants of a modest and contented 
people. 

163. By the 12th we managed to get into some sys- 
tem and organization. Temporary hospitals (sheds) 
were built; a steward, cooks, nurses, etc., located there- 
in, under the excellent medical attendance of the Resi- 
dent Physician, Dr. de Beaubien, and several advanced 
students who resided in an adjoining building. These 
sheds were got up in a hurry, and were, of course, 
very imperfect in structure and furniture for the first 
few days, because it was no easy matter to get work- 
men to expose themselves in such a pestiferous place. 
For want of cots and beds, straw was thickly laid on 
the floor as a hurried means of some comfort. As 
usual in such times, an ignorant newspaper editor (a 
pest to society) and a pair of intermeddling, discon- 
tented parsons made one visit to the place — a short 
one, for they were fearful of their own persons — and 
early the next morning their paper came out with 



ITINERARY IN CANADA. 181 

venomous diatribes : " the sheds ought to be called 
slaughter houses; we found the patients lying on 
straw on the floor, no bedsteads, no beds; we turned 
away in disgust !" How easy it is to censure, when 
one is under the protection of the " liberty of the 
press/ 7 and comfortably seated out of responsibility 
and danger! Had the libelers made a true state- 
ment, they should have stated that the condition of 
the shed was the best that the anxious authorities 
could procure in so short a time — a time of panic. 
As soon as workmen could be had, trestle bedsteads 
were supplied, palliasses, sheets and pillows; but 
these guardians of the public never returned to see 
the " slaughter houses/ 7 and to withdraw their libel. 
Wine, brandy, cordials ; condiments, the best of fresh 
meat and poultry, were supplied without stint, also 
unremitting care. The Resident Physician was at 
his post at five o'clock in the morning; the students 
remained night and day, assiduously administering to 
the wants and comforts of the patients. Did the edi- 
tors and psalmodists "do likewise ? 77 Only once, and 
that was to make a " sensation paragraph. 77 The only 
clergymen unfearful and unremitting in attendance 
were the Sulpician Roman Catholic clergy; occa- 
sionally, but very rarely, a Protestant Episcopal, and 
one Presbyterian clergyman, paid a hurried visit to 
the " slaughter house. 77 Dr. de Beaubien at once es- 



132 ASIATIC CHOLERA. 

tablished a burial ground at a distance on the com- 
mon .kept graves ready open to receive the dead, and 
buried them as soon after death as possible. He 
used chloride of lime freely there, in and about the 
hospital. Almost every one that died he carefully 
examined, or had the autopsies conducted by his as- 
sistant students, as soon as no doubt remained of 
death, and carefully observed what the scalpel could 
reveal. I feel it to be my duty to bear the above tes* 
timony to the meritorious conduct of the parties 
concerned, although I have had no intercourse with 
them since thirty years. 

164. The next sanitary step to meet the anxious 
Wants of the public, but of little real use, was to 
establish a number of dispensaries, under the care of 
trusty students who had instructions for their guid- 
ance. These places were supplied with necessary 
drugs, and given to all who applied, night and day, 
gratuitously. Whatever good they may have done, 
one thing is certain, it contented the people. 

165. At the outbreak of cholera Montreal had a 
population of 32,000 souls and thirty licensed physi- 
cians and surgeons, two small schools of medicine 
and a number of students. On the regular practi- 
tioners devolved all the duties of medical attendance, 
about one practitioner to a thousand well and ill per- 
sons, if equally divided, which was not the case. 



ITINERARY IN CANADA. 133 

There were three hospitals— the long established 
Hotel Dieu, the Gray Nuns' Infirmary, and a new 
and excellent establishment, the Montreal General 
Hospital, well conducted. Such were the only medi- 
cal means to meet an appalling pestilence, hitherto 
unknown to Canadian practitioners, and who, like 
all over elsewhere, supposed the plague to be a dis- 
ease, and consequently brought to their aid the dog- 
mas of the schools — physiological axioms that had no 
bearing on the complaint, and which cholera refuted. 
The metliodus medendi founded on such principles 
had no application here, proved useless in every 
case, and injurious in many. But scholastic educa- 
tion enables the weak minded to argue with an ap- 
parent display of real knowledge, and to override 
and subdue common sense. 

166. The town of Three Rivers, half way between 
Quebec and Montreal, forbid steamers to come into 
their port, by which restriction the inhabitants 
escaped for a while, until some retrograde traveler 
from Sorel, above, brought the pest among them; 
but it did not spread much. Sorel, a steamer port, 
was early affected, but had few cases. This is easily 
explained, as that borough contains a divided popu- 
lation that keeps each aloof from the other, and is 
very unsociable, On both banks of the St. Lawrence, 
with a dense population, scarcely a case occurred 
1 



ASIATIC CHOLEBA, 

before six weeks, because no direct communication 
with Quebec existed — and no travel in the agricul- 
tural season takes place, excepting that of going once 
a week to the parish church. 

167. From Montreal it was different: the great 
influx of emigrants was forwarded away by the Emi- 
grant Society as fast as they arrived, and by them 
the pestilence was sown at each stopping place. 
Lachine first, then The Cedars, next Coteau-du-Lac, 
Cornwall, Prescott, Kingston, Toronto, Niagara, etc., 
to Sandwich, in Upper Canada, and to the opposite 
towns in the State of New York, spreading from 
town to town until it reached New Orleans. From 
Montreal to St. John's, thence through Lake Cham- 
plain, infecting the New York towns of Champlain, 
Chazy, Plattsburgh and White Hall, to Albany; on 
the Vermont side attacking Burlington, and extend- 
ing to the interior towns of the State; but in all these 
places the great fury of the invasion seemed to have 
already expended its greatest force in Lower Canada. 
Although I have the dates of the successive marches 
of the pestilence from Montreal through Upper 
Canada, and into the United States to the Atlantic 
sea-board, and down to New Orleans, I abstain 
giving the calendar, that I may not overload this 
small book. 

168. However, I must notice the march of cholera 



IT1NEBAKY IN CANADA. 135 

Up the Ottawa, because the itinerary is exact and 
particular. In 1832 the banks of this river were still 
lined with the primeval forests, and small settlements 
existed only here and there at special landing places, 
as the current is frequently interrupted by rapids, 
cascades, and unavoidable " portages." 

169. Travelers up the Ottawa carried cholera to 
Carillon, Greenville, Point Fortune, Fox Point, on 
one side of the river, on the other to Rigaud, New 
Longueil, Plantagenet, etc., to Bytown, the terminus 
of travel, which place it reached 5th July, brought 
there by a woman passenger on steamer Shannon; 
she died the day after landing. Next day died the 
landlord of the house she was taken to, also the 
people in attendance on her and him; 88 died. At 
Rigaud there died 80, from the 8th July to 9th 
August. On the 10th Dr» Teasdale died. New Edin- 
burgh, near Bytown, was dreadfully ravaged. At 
Plantagenet, Ottawa, died Mr. M'Kay, a young man 
in the service of Mr. Chester, 14 miles away. His 
mother went to his relief. On her return she took 
ill, and died in a few hours. Mr. Chester, Sen., took * 
ill at once and died; Mrs. Chester died. Many neigh- 
bors attended her funeral, took ill, and all of them 
died; Miss Chester died; her brother, Guy Chester, 
died, and a sister, Mrs. Molloy, died. 

170. When it is considered that this was a new, 



136 ASIATIC CHOLERA. 

a forest country, and remarkably healthy, and that 
the pest was brought there and immediately scourged 
the people who communicated with each other, and 
to none other, we leave to the theorist to find and 
explain any other cause than contagion for what is 
now mentioned. 

171. Opposite Lachine is the Iroquois village of 
Caughnawaga. Here 88 Indians died. These people 
were much exposed to the pest being brought among 
them from the occupation of the men, which was that 
of piloting rafts through the rapids. At the Lake of 
Two Mountains is a village of Iroquois, and an ad- 
joining village of Algonquins; but here only two died. 
The explanation is easy. As soon as summer is set in 
the most of the people depart to the hunting grounds, 
and the few, with women, that remain, do not travel 
about ; nor is their place a thoroughfare of travel, as 
is Chateauguay, where, from the 14th June to 16th 
of August, 146 died. 

172. A case of second attack took place in Mon- 
treal August 13th, and ought not to be passed over in 
silence. Mr. Alexander Gray, of the firm of Gray & 
Co., auctioneers, aged 31, took ill on Sunday and 
died early on Monday, the 13th. He had quite 
recovered from a former attack, and attended to busi- 
ness more than a week, when he was suddenly killed 
by this second attack. There were other instances of 



ITINERARY IN CANADA. 137 

a second attack, but it is sufficient to notice one by 
name and date. 

173. August 9th. Rev. David Hughes, Unitarian 
minister of Yeoville, Somersetshire, England, aged 
47 : on Thursday he left his family, in perfect health, 
in company with his eldest daughter, to go to Upper 
Canada. While on the boat, from Lachine to the 
Cascades, he was ill; there were no berths, and he 
had to recline as best he could. At The Cedars they 
took the stage to Coteau-du-Lac; by this time he suf- 
fered much from vomiting and purging, but could not 
prevail on the driver to stop more than once or twice. 
When he got to the Coteau a doctor said he must not 
proceed. He continued cramped for some hours, was 
deeply blue, and died at 8 p.m.; was conscious to the 
last, and was hurriedly buried in« the night. Now 
comes the important part of the case. His distressed 
daughter returned to Montreal, and either took back 
or sent back his luggage. Among this was a carpet- 
bag containing some of the foul clothes he had worn. 
This carpet-bag was taken into the garret of the house 
where he had resided in Montreal, Mr. Ariel Bow- 
man's, bookseller, St. F. Xavier street, and hung up. 
The Sunday following, his youngest daughter, who 
remained behind at Mr. Bowman's, went to play with 
two of Mr. Bowman's children. They took down the 
bag, overhauled the contents; in a vest pocket Miss 



138 ASIATIC CHOLERA, 

Hughes found a copper cent, took it as a remembrance 
of her father. This was Sunday afternoon — the whole 
household perfectly healthy at the time. At 4 a.m.. 
20th Aug., Monday, I was sent for to see two of Mr. 
Bowman's children; they were both choleraic — very 
bad; these were his two children who had overhauled 
the carpet-bag. After prescribing for these two, a 
message came for me to go to another part of the 
house; there I found Mr. Hughes' second daughter, 
Sarah Hughes, 11 or 12 years of age, very ill of 
cholera, of which she died in two or three hours more. 
This girl went to bed perfectly well, and could not 
have been ill over seven hours. Mr. Bowman's two 
daughters recovered. These three cases are interest- 
ing, as affording an instance of cholera derived from 
"infected goods." * Sept. 18th, Mrs. Bowman, wife of 
Ariel Bowman, took cholera and died. Heretofore 
no cholera existed in this salubrious street, excepting 
the cases of Levi Adams, his wife and maid, on the 
20th June. 

174. The garrison of Montreal consisted of a part 
of the 15th and a few of the 27th regiments, some of 
the men doing outpost duty not far off — 450 men in 
all; of these, 46 died. On the 19th June the colonel 
encamped his men, under canvas, on the Island St, 
Helen, maintained strict exclusion and seclusion and 



ITINERARY IN CANADA. 139 

perfect hygiene; the result was that no more deaths 
occurred among them. 

I must notice a few exceptional cases. It will be 
seen that a large number of the attacks were, without 
the least premonition, of an astounding character — 
killed in a few hours ; but a good many of these 
attacks seemed to have at once purged the system of 
the poison, and such patients recovered in twelve to 
eighteen hours. This was the case with Mr. Gray, 
the auctioneer. (See Sec. 172.) 

175. On the night of 15th June, a man whom I 
knew by sight, but not by name nor residence, came 
into the office, about 12 o'clock; when it came to his 
turn I asked what he wanted; he said he came for a 
coffin for his wife. I gave him an order for one, with 
which he went off. Before 1 a.m., the same night, 
a close and very hot one, among others a man came 
on the same kind of errand, and said, casually, that he 
passed a man lying on the pavement opposite the 
English Episcopal Church, not over 2,000 yards from 
my office. At once I sent to his relief. It turned out 
that the man was dead, cold, and very blue, but there 
was no appearance of his having vomited; in his vest 
pocket was found the order given to him for a coffin 
for his wife, less than an hour before. The body was 
sent to the dead-house, Place d'Armes, and thence in 
the morning to the trenches, I did not know his 



140 ASIATIC CHOLERA. 

name, and believe that his friends, if he had any, 
remained ignorant of his sudden death. This case is 
cited to show how sudden some of the deaths were. 

176. A horse. John Armstrong, master tanner, 
lived in a two-story house on St. Antoine Bridge. 
One of his men took ill of cholera, and for con- 
venience 7 sake lay on a buffalo-robe on the floor; t 
he soon died. The robe was taken to the stable and 
thrown into a manger next to the horse, a very fine 
one. Next day I was called to see Armstrong, ill of 
cholera; some one came in and said the horse was 
choleraic. I went into the stable, found the horse 
standing up, drooping, his ears hanging, his skin 
damp and sticky to the hand, mouth and tongue cold, 
breath cold, eyes dull and undistended; incessant 
purging of choleraic matter, the ingesta of food hav- 
ing previously passed away; there was no vomiting, 
because the structure of the cardia in the horse does 
not admit of vomiting. The horse soon died. 

177. Poultry died in some places in the St. Antoine 
and Quebec suburbs of the city, with all the appear- 
ance of cholera. Dogs were also reported to me 
as having died of cholera. But on neither of these 
instances do I set much value, for fowls are subject 
to a disease resembling cholera, and dogs, in hot 
summers, are very subject to vomiting, and diarrhoea, 
and convulsions, However, in India the reports 



ITINERARY IN CANADA. 141 

state that these animals died off in great numbers; 
and at Marienburg, Prussia, it is asserted that fish in 
preserve ponds died of cholera (!) — from the single 
pond of Dimperberg 40 tons were buried. But it is 
well known that many poisons mixing in the water 
will in an hour kill the fish it comes in contact with. 
Potash is one of these deleterious substances, and 
only a little will empoison a large extent of water, 
and kill every fish it comes in contact with. This 
was remarkable after the great fire at Mirimachi, 
that destroyed miles of forest, about forty years ago; 
the rains carried the alkali into the bay, completely 
i destroyed all the salmon of that year, and greatly 
added to the distress of the people. Swine, it is 
said, took cholera in Ireland and died. 

178. No correct register of the numbers of inter- 
ments at the Roman Catholic burial ground was 
made — indeed, none could be made; for during nearly 
two weeks the carters carried the dead to the 
trenches, not knowing or caring to know the name 
or even the sex of the body. They picked up, as it 
were, the bodies as they went along the streets, or 
were sent for to cart away; they were common 
laborers, who could not even read, and, of course, 
were incapable of making a list, beyond noting the 
I number they carted, to draw pay for so doing. At 
the Protestant burial ground affairs were not so bad, 
7* 



142 ASIATIC CHOLERA. 

as the numbers taken to them were much less, and 
most of them of a better class, who had friends to 
attend to the burials. 

179. It is, perhaps, well to say a few words about 
the Board of Health, consisting of ten to fifteen 
magistrates and gentlemen— -a body quite outside of 
the Medical Commission, and having only advisory 
powers , but no right to interfere; nor did they once 
intermeddle or give us any trouble. They appointed 
a secretary, at a small salary. This gentleman, J. 
Guthrie Scott, Esq., attorney, was a very timid man, 
and never once left his house to attend the meetings 
of the board. His office appeared to be that of col- 
lecting daily reports of cases and deaths; but he 
never once sought for the reports himself. He 
managed to get occasionally a partial statement by 
sending a note for it, and send this imperfect docu- 
ment to the newspapers. I find it necessary to note 
this, lest any one who may look over the files of 
papers for this period should be led into the very 
contradictory errors recorded. Mr. Scott was, as 
above said, a very timid person. He had recourse 
too largely to brandy to keep out the pestilence; it 
overcome him and his judgment, and, becoming a 
habit, soon terminated his existence. With this 
exception he was an unblemished gentleman. 



ITINERARY IN CANADA. 143 

As examples of the reliance to be placed on Mr. 
Scott's " Reports/ 7 take the following: 

" June 13— Cases, 94. Deaths, 23. 
June 15— Cases, 1,204. Deaths, 230. 
Up to 16— Cases, — Deaths, 102. 

" J. G. Scott, Sec." 

The editor of Canadian Courant, Sept. 5th, says: 
total cases, 4,385; deaths, 1,853. The editor goes on 
to say, on his own account, at least 2,000 have died; 
and again he says, from June 10th to September 18th, 
deaths, 3,151. Where Mr. Scott got his numbers I 
cannot imagine; but I notice in the newspapers that 
he attached my name to some of his reports. It is 
certain he never once called to see me nor sent to 
me for a report. Nor can I say more in favor of the 
Canadian Courant. Both these sources, and all the 
published accounts, are equally erroneous. Canadian 
Courant, 20th, says, many shops in St. Paul street are 
shut up. A great many persons have fled the city to 
escape, and were seized with cholera on their road to 
an imagined place of safety. 

180. The Hotel Dieu Hospital, a cloister, had 
only one case; the Congregation Nunnery had none; 
the Gray Nunnery Infirmary had only two; and the 
jail only one (perhaps two). A number of doctors 
and apothecaries died, and several priests in the 
parishes. One paper estimated that the total number 



144 ASIATIC CHOLERA. 

of deaths in Lower Canada, with a population of 
500,000, exceeded that of Great Britain, with a popu- 
lation of 15,000,000. 

181. For the first fifteen days cholera was princi- 
pally confined to the two cities of Montreal and 
Quebec, while both shores of the St. Lawrence be- 
tween these places nearly escaped. But, at last, the 
pest spread from Quebec to Point Levi, opposite, and 
was gradually extended from parish to parish; many 
of these suffered, statistically, greater mortality than 
did the two cities. 

182. From my notes, and disbursements to carters 
and for coffins, I venture to say that the deaths in 
Montreal reached quite to 4,000, if they did not 
exceed that number a little. By September 29th 
cholera had ceased with us. 

183. A few words only will suffice for the cholera 
of 1834. It did not appear with us until 11th July, 
and ceased by the end of August. While we had 
some cases of astounding cholera, the number was 
less than in 1832, and taken altogether it was a 
much less disastrous plague; but it extended like in 
1832, from person to person and place to place, in no 
instance until a contaminated person had preceded 
the outbreak. 

Of Quebec, with a population of 28,000, 1 shall 
speak only as I derived information from the news- 



ITINERARY IK CANADA. 145 

papers, one of which was always considered reliable, 
Neilson's Gazette. June 27th, the Gazette states the 
deaths in Quebec to that date at 1,200. June 8th to 
July 3d, 1,421 deaths; to July 18th, 1,662. " No 
correct estimate of public health can be made from 
the reports. In the hospital there have been 943 
cases, and 590 deaths. But this hospital received 
many emigrants; this was not the case in Montreal. 
The number of deaths are more likely to exceed than 
be under 4,000." 

The Quebec papers teemed with censures of the 
cholera authorities — with what justice I cannot say, 
as my office was confined to Montreal. I have no 
doubt they often expressed no more than the personal 
feeling of the writers, and some excuse must be made 
for excitement during a public calamity, in which 
newspaper scribblers notoriously take great liberties 
with persons who are otherwise occupied, and who 
scorn to reply to attacks made in the safe quarters of 
a newspaper office. 



CHAPTER VI. 

PATHOLOGY. 

184. Let us begin with the blood — not that it is 
the first thing disturbed, but because we must begin 
somewhere; not that any change in its appearance is 
a cause of cholera, for its change is due to the chol- 
eraic poison; not because it plays any role of import- 
ance, for all its action is absolutely negative — it does 
nothing; it ceases to perform even its allotted office 
of calorification. Its stagnation on the surface is 
what first attracts our attention; and if we look into 
the interior, before or after death, we find the same 
stagnation, excepting in the larger vessels, where it 
only fluctuates to and fro, but does not circulate in 
severe cases. 

185. Here we at once come into collision with 
that rough and superficial physiology taught while 
studying descriptive anatomy. 1st. It is daily 
taught in schools, and published in systems, by pro- 
fessors who initiate the student into the recondite 
but as yet imperfect science of medicine, that blood 



PATHOLOGY. 147 

is essential to animal existence; this doctrine is most 
untrue. 2d. It is taught, and believed by superficial 
practitioners, that the tissues are elaborated out of 
blood; this is untrue. 3d. Consequently, that there 
is a daily consumption of much blood; this is untrue. 
4th. It is taught that, to supply the consumption, 
more blood must be made daily; this is untrue. 5th. 
It is taught that food chymified and chylified is 
the pabulum out of which blood is made; this is un- 
true. 6th. Impressed with this roundabout way of 
making blood, which blood so made daily is to cre- 
ate and be changed into tissue, the teacher has im- 
agined that the chyle, in its progress towards mixing 
with real blood, gradually becomes tinged red, 
" almost evidently " so, while yet in the thoracic duct, 
when it has reached near the subclavian vein; this is 
also untrue. My belief is, in this instance, like a 
thousand others, the teacher, imbued with the idea of 
a necessity of blood, has persuaded himself that he has 
seen the progressive steps of that creation. As early 
as in 1815, and for years after, I undertook many 
physiological researches on digestion and on this 
supposed creation and use of blood; but I was dis- 
appointed. I fed many cats, dogs, pigs, etc., and ex- 
amined the chylopoetic system at various stages of 
digestion; but my disappointment was great in not 
meeting with what I had been taught to believe. I 



148 ASIATIC CHOLERA. 

rarely met with even a tinge of red in the thoracic 
duct. This was one of my first sources of skepticism 
of the truth of doctrines. It is only yesterday, as it 
were, that a contributer to the Philosophical Trans- 
actions managed to get accepted a paper, and a draw- 
ing to illustrate it, that he observed, in the micro- 
scope, a blood globule unroll itself into a fibre to be- 
come muscular tissue ! I believe his name was New- 
port, but I have not the Transactions to refer to. 

The foregoing digression I think proper to make, 
so that I may not be misconceived in what I have to 
say about blood in cholera. 

186. Choleraic blood, in the cyanosed state, or in a 
protracted case, or shortly after death, is found to be 
of so deep a purple color as to appear nearly black. 
It is viscid from the absence of serum and much of 
the fibrin. The interpretation is, that while the 
diluting serous fluid has been drawn off, the globules 
have remained, concentrated in number, and dark 
from the absence of aeration. The anatomical charac- 
ter of the globule is not altered; it preserves the disk 
form, when taken out of the sinuses and great vessels; 
but, if the blood be examined in the capillaries, it will 
be found that many globules are diffused extra vaso- 
rum; and that, in a protracted case, many will be 
found either broken down, or that their hsematin has 
escaped, so that the rete mucosa malpighi becomes 



PATHOLOGY* 149 

permanently stained, which is the cause of the pro- 
tracted color seen in cases called the typhoid stage. 

187. The heart and great vessels near to it are all 
filled with thick viscid black blood, which blood con- 
tains an amount of globules vastly in proportional 
excess of ordinary blood. The right ventricle and 
auricle are always full, and the left is nearly in the 
same state. The pulmonary artery and vein show no 
difference in the quantity of the blood they contain. 
All the arteries contain some black blood. This 
should be anticipated by a physiologist well ac- 
quainted with the movement of the blood in these 
vessels during life, also after death. It is stated by 
professors that the arteries are empty after death; 
true — excepting in special cases reported as sud- 
den death, and death from lightning; but such cases 
I have not examined, and do not know the fact from 
my own knowledge. I shall now stop a moment 
to say a few words on empty arteries after death. 

188. In disease the course of the blood through 
the vessels does not cease at death, at the' arrest of 
the impulse of the heart on the arterial column. The 
veins continue to deplete the arteries of their blood 
for several hours after what is called death has taken 
place. This depletion is due to a suction property 
in the extreme veins, a power so great that all the 
blood in the arteries is drawn out, and the round caK 



150 ASIATIC CHOLERA. 

iber of the arteries is forced into a flat cord, in spite 
of the strong resistance of the arterial coat, ceases 
by tending to resume the cylindrical form, but can- 
not do so unless something enter to replace the vacu- 
um which the venous suction has created. If a large 
artery, like the carotid or the femoral, be carefully 
laid bare, it will be found empty, and of course flat; 
but, as soon as a cut is made into it, admitting a 
rush of air, the vessel will at once expand and be- 
come an empty cylinder. This I have taught many 
years ago, and should not now recur to it were it not 
that not a word on the cause of empty arteries is to 
be found in class-books. 

189. In cholera the veins quickly cease to act, 
draw no longer on the arteries, and consequently do 
not influence the motion of what blood remains in 
the arteries, which is necessarily black, since the 
lungs cease to aerate the blood many hours before 
death; the heart still acting, causes only a flux and 
reflux of the blood nearest to it, but effects no cir- 
culation. Under these extraordinary circumstances, 
it must be expected that blood of a black color will 
be found in the arteries. 

190, It is curious to see both arteries and veins 
equally filled with black blood, coursing languidly 
through the mesentery during life, as I have seen in 



PATHOLOGF. 151 

the Cesarean sections performed with the delusive 
hope of saving the life of a foetus. 

191. Cavity of the skull and the brain are the next 
places where pathological change has often been as- 
serted to exist. When the calvarium is removed, 
the dura mater and the sinuses cut across, a large 
quantity of the same kind of blood seen in the heart 
will run out. A very limited knowledge of the 
brain-box would anticipate such a state to exist in 
cholera: first , the brain substance, like all other 
parts, would be drained as well as all the arachnoid 
liquor, and, of course, diminished in volume; second, 
as this osseous cavity is closed on all sides, except- 
ing where vessels enter and leave, should the brain 
diminish, blood would, of a physical necessity, rush 
in to fill the vacuum. Hence it is that, in many other 
cases than cholera, the sinuses and vessels within the 
skull are found to contain more blood than when the 
brain has not been diminished in size. The pneuma- 
tism of a closed cavity, with unyielding walls, will, 
of necessity, suck blood from the nearest sources to 
fill the vacuum. This has been fully demonstrated 
more than fifty years since. Notwithstanding this 
simple physical truth, the presence of this insolite 
quantity of blood is everywhere called — • 

192. Congestion, " The brain is much congested in 
cholera" is repeatedly stated, as if congestion of a 






152 ASIATIC CHOLERA. 

part constituted a diseased state there. The hack- 
neyed word congestion is much in use, and a very 
convenient one to explain to the ignorant something 
which he who employs it does not exactly know 
himself, and which does not exist, and if present any- 
where does not constitute a diseased state. If con- 
gestion were disease, scarcely any young woman 
would be free from disease of the face, since she often 
has even extreme congestion of the face, a conges- 
tion that rapidly comes and goes and leaves no trace 
behind. Congestion of the sexual organs is, I fancy, 
very common in both sexes, and is sometimes much 
prolonged and often repeated, but does not disorder 
the part in which it exists or produce inflammation, 
which is a disease. There is scarcely a single viscus 
concerned in nutrition that is not necessarily con- 
gested daily, but leaves no trace of disorder. This 
word is the creation of a pathologist's imagination, 
who, when he cannot on dissection discover the seat 
of a disease he is in search of, but finds a cadaveric 
appearance due to accumulation of blood, after death, 
does not hesitate to exclaim, great congestion! Med- 
ical writings teem with this convenient word. 

193. Having sufficiently discussed the circulation, 
or rather the presence of blood in the vessels, let us 
now contemplate the blood itself. 

194. Choleraic blood. In order to comprehend 



PATHOLOGY. 153 

Well what change cholera has exerted on the blood, 
it will be well to say a word about healthy blood, 
which varies greatly in the quantity of serum present 
at different periods, even in the short space of twenty- 
four hours. When it was the fashion to bleed 
largely from the arm in pleuritis, some years since, 
to the amount of 100 to 200 ounces of blood in three 
or four days, the proportion of serum towards the 
last bleedings was greatly in excess, at least twice 
more than what appeared in the blood first drawn. 
And as regards fibrin, while the quantity appeared 
great, it was not so, since it was thin and loose. The 
proportion of red globules was still more diminished. 
These facts were well known then, and accurately 
explained thus : the first ten to twenty ounces drawn 
abstracted equally of the three constituents of the 
blood, serum, fibrin and globules; each successive 
abstraction took away equally of what remained; 
but as fibrin was less rapidly generated than serum, 
it diminished with each bleeding; and as regards the 
globules, which require a long time to be created, 
they were greatly less in number than any of the 
three constituents, and in certain constitutions are 
never fully restored. The volume of what is called 
blood in these cases is restored to its maximum each 
day by the fluids drank by the patient; but this vol- 
ume is not ordinary blood — it is diluted blood. 



154 ASIATIC CHOLEHA* 

195. Now observe what takes place in cholera: 
the very reverse of what has been just mentioned. 
The serum is nearly all quickly drained off; the 
fibrin is decomposed, and scarcely enough remains to 
hold the globules together; while nearly all the 
globules remain behind. 

196. Salts in choleraic blood are rapidly dimin- 
ished, so much so that in severe or protracted cases 
scarcely any remain. Free alkali is totally absent, 
and the neutral salts are mostly absent; but these 
salts are found abundant in the white matter dis- 
charged from the bowels. 

197. Inflammation. From what has been stated 
it must appear that inflammation cannot exist in any 
part of a choleraic patient. In the cyanosed state a 
blister cannot be raised by cantharides, nor by boiling 
water, moxa or red-hot iron. In mild cases, and on 
the turn of a case, mustard I have seen act and 
redden the skin. 

198. One memorable instance of the headlong 
blindness that adheres to certain schools must be 
mentioned. "When cholera invaded western Europe 
in 1831, inflammation, or its cousin congestion, was 
still greatly in vogue, and led practitioners to pre- 
scribe accordingly. One celebrated professor, Del- 
p&che, deeply tinctured with the doctrine, boldly 
declared throughout Europe that he had discovered 



PAffiOLOGY. 155 

the seat and cause of cholera — it lay in an inflam- 
mation of the semilunar ganglion* Being a professor 
and a great man his assertion was quickly copied 
into the medical press. He was convinced of his 
discovery; it needed only bleeding to effect a cure. 
He went among the different seats of medical learn- 
ing demonstrating his discovery, and succeeded in 
convincing all those who bow in reverence to a name, 
until he reached Dublin, where, with a confidence 
that did honor to his enthusiasm, he would again 
demonstrate his discovery in the Irish schools. A 
subject was on the table, he opened the abdomen, 
searched for the ganglion, showed it in triumph — a 
red body — being red it was, of course, inflamed. But, 
lo ! what a sudden fall from the pinnacle of great- 
ness to utter insignificance was there when the 
Dublin anatomist, Harrison, demonstrated that Del- 
peche's ganglion was simply a lymphatic gland, 
colored by stasis (congestion); and by a further 
search he, Harrison, exposed the real semilunar 
ganglion, healthy, and which the professor of Mont- 
pellier had so often thought he had demonstrated, but 
could no longer find. At once the professor fell into 
deep oblivion, until his tragical end brought him 
once more before the public in contempt and pity. 

199. The stomach and intestinal canal are much 
contracted, dark colored from congestion. The 



156 ASIATIC CHOLERA. 

mucous membrane is soft, and more or less covered 
with that white matter which is characteristic of 
cholera. 

20(K The omentum and intestinal adeps are greatly 
diminished, and both are dark colored from stag- 
nant blood. The parietal and visceral peritonea 
have lost their clear, shiny appearance, and are quite 
dry. 

201. The liver does not look much changed, 
except being darker than usual. The gall bladder is 
always full of bile, apparently natural, while the 
hepatic and common ducts are pervious and offer no 
obstruction to its escape. Here naturally arises the 
idea, how happens it that the violent and repeated 
straining to vomit should have spared the gall 
bladder — for, besides being always found full at 
death, during life it poured no bile into either the 
stomach or intestines. 

202. Of the spleen I have no distinct recollection, 
beyond remembering that it was small. 

203. The kidneys suffer no alteration. The uri- 
nary bladder is always empty, and of the form men- 
tioned in Sec. 135. 

204. All the serous membranes, peritoneum, 
pleura, pericardium, arachnoid, are dry. Ascites 
and hydrothorax, as well as hydrops pericardii, are 
quickly oozed away. Varicose ulcers, and all other 



PATHOLOGY. 157 

ulcers and sinuses, dry up, but to return, should the 
patient recover. Two cases of most virulent and 
copious gonorrhoea ceased at once, but returned on 
recovery from cholera. 

205. The muscles are harder than usual, and dry. 
On this account, the great diminution of fat, and 
very slight tendency to decomposition, cholera sub- 
jects answer admirably for dissection. 

206. Adipose substance is greatly diminished in 
quantity. A patient who has oozed largely by the 
skin quickly grows lean, the features shrink; in 
many cases, especially of plump, fat-faced girls, the 
skin of the cheeks approaches the malse, the lips be- 
come thin, the nose sharp, the eyes deeply set back 
into the orbits, the corneas flaccid, and the conjunc- 
tiva quite dry. In one short, thick-set lady of fifty 
years of age, who, before the attack, was remarkable 
for a protuberant abdomen, due to a great accumula- 
tion of adeps between the muscles and skin, her case 
was severe, but she recovered sufficiently to run into 
the " second stage," and died on the tenth day, when 
the heretofore plump belly was greatly reduced, the 
skin lying in flabby folds. Within the abdomen the 
omentum is much reduced, the mesentery also, as 
well as the fat about the kidneys. In naturally lean 
persons the subcutaneous cellular tissue is tough and 
less easily cut than in cases of death from other 

8 



158 ASIATIC CHOLERA. 

causes than cholera. The heretofore plump hand 
becomes lean; the skin on the back of the hand lies 
against the tendons; the fingers become lean and 
shriveled, like when long soaked in water. 

207. The contemplation of this great waste of 
adeps leads us to approach the subject of etiology of 
cholera, and to inquire what it is that has pro- 
duced this great change in so short a time as to 
leave so little fat remaining in some cases; while in 
all known diseases fat disappears from two causes 
only: one, want of supply through deficient nourish- 
ment; the other, it is removed by absorption — both 
slow processes, of long duration, while in cholera 
the removal is effected in a few hours, and without 
the intervention of absorption and elimination. 

208. The itinerary of cholera, and its attack of 
the healthy only after they have been exposed to one 
already infected, or to infected materials, clearly 
prove that the immediate cause is a poison imbibed 
by the patient, who, in his turn, generates the same 
kind of poison, capable of infecting others; but what 
the poison is like cannot be demonstrated; it is known 
only by its effects. Nor can the contagious principle 
contained in any known morbid poison be demon- 
strated; for instance, the pus of syphilis, variola, the 
exhalation from measles or scarlatina, well known 
diseases, there is no possibility of showing it, and can 



PATHOLOGY. 159 

only be known by the effect it produces. We are 
tben forced, in cholera, to infer, as we do in all dis- 
eases, that something has been introduced into the 
system which creates the disease. In the case of chol- 
era, after studying the phenomena that the disorder 
invariably manifests, we are forced to believe that a 
poison has been introduced into the system, which, 
totally unlike any poison the product of disease, pro- 
duces no disease, but, instead, a certain catalysis or 
liquefaction of certain elements of the body, the na- 
ture of which liquid so produced has a strong and 
rapid tendency to reach the cutaneous and intestinal 
surfaces in a direct way, ooze through the intervening 
tissues, without the assistance of absorption, circula- 
tion and secretion — for all these functions are abso- 
lutely suspended in cholera. But the direct transuda- 
tion does not depend altogether on the quality of the 
new formed fluid, but does in a great degree depend 
on an unknown change in the tissues that give it pas- 
sage, is abundantly proved by the facility with which 
saline injections escape, almost as soon as forced into 
the veins — escape in the same way as the cholerab 
matter does. 

2f)9. The serum of the blood, and the juices con- 
tained in the muscles, rapidly ooze out, but not as 
serum; the fibrin of the blood is also drained away, 
but not the globules. The fat is removed, but not in 



160 ASIATIC CHOLERA. 

the quality of fat. Neither serum, nor fibrin, nor fat 
can be detected in the escaped matter, which is of a 
uniform and special character, quite different from 
the materials from which it is derived, and is a new 
creation. Nay, more, the fluid of dropsies, such as 
ascites, hydrothorax, hydrops pericardii, and, per- 
haps, ovarian dropsies, also abscess, like milk abscess, 
and that of fluctuating bubo, are all converted into 
the special choleraic fluid, and as such is discharged 
from the system. 

210. We must then infer that the choleraic poison, 
whatever it may be, has the power of converting cer- 
tain constituents of the body into a special liquid, 
hitherto unknown; also of converting deposits, the 
result of disease, into the same. Its power is cata- 
lytic over certain tissues and deposits, and the result 
is a colliquation. 

211. The great strides organic chemistry has 
made since half a century comes to our aid, and fur- 
nishes us with analogical facts illustrative of the mu- 
tations referred to. 

212. The generation of the choleraic poison, like 
that of all known morbid poisons, is due to vital 
action within the person. It is more rapidly created 
in some constitutions than in others, for we find that 
a healthy person, landing in a contaminated place, 
has been attacked within twelve hours after expo- 



PATHOLOGY. 161 

sure; but, in the majority of cases, a period varying 
from twenty-four to ninety-six hours intervenes be- 
fore the break-out. This poison, like all morbid 
poisons, undergoes a period of incubation, as it is 
called, before it can act on the patient. The same 
thing occurs in all cases of morbid contamination. 
Inoculated variola takes nine days' generation in the 
system before it kindles fever — the subsequent stages 
of the disease being periods of three days each. 
When variola is taken spontaneously from the atmo- 
spheric contagion there intervenes a period of fifteen 
to eighteen days of uninterrupted health before the 
commencement of syaxhus, after which the periods 
of the stages are similar to those of three days each, 
like in the inoculated cases. Other poisons, such as 
scarlatina, measles, etc., have each its period of incu- 
bation, during which the health of the patient is not 
altered. The received contagion lies apparently 
dormant for a while, long enough to generate the 
necessary quality and quantity of poison (lately 
called ferment or zymosis) to set up the same dis- 
ease in a new patient. An analogous process is 
comparatively carried on in cholera, but here there 
are no periods of definite duration; the only one 
it has is of colliquation, arrest of circulation and 
aeration. 
313. We are forced to believe that this poison, 



162 ASIATIC CHOLEHA. 

like those already mentioned, and many others, does 
not manifest its power until it has acquired a certain 
quality, also quantity; for, if only partially created, 
like in case of ordinary ferments which metamor- 
phose vegetable bodies, it may prove defective in 
quality and consequently inefficient, or it may be 
insufficient in quantity to overcome the resistance 
that some constitutions offer to its virulence. We 
may also suppose that in those cases which run a 
rapid course, terminate suddenly and leave the pa- 
tient restored to health, only weak for a day or two 
after, that the poison was insufficient to colliquate 
the whole system, like in bad cases. While in other 
cases the poison will be sufficient to saturate, as it 
were, the system, and act until death results; or, that 
the idiosyncracy of the patient will resist, and an 
end to the storm is attained, leaving an exhausted 
economy, with a flickering vis medicatrix naturce, 
which attempts to make a cure, or not, and run into 
" the typhoid state." 

214. We may suppose or imagine that the period 
of incubation and complete generation of the poison 
was a diseased state of the system for the time being; 
if so, it is the only period in which disease exists, 
though it is never manifest. But the moment the 
poison operates, it causes a complete cessation of 
nearly all the usual physiological actions— circula- 



PATHOLOGY. 163 

tioi), aeration, calorification, digestion and its se- 
quents — repair and elimination — are all completely 
arrested, while the cerebral function remains undis- 
turbed, independently of the cessations just named. 

215. The action of the poison establishes a colli- 
quation by means of a hitherto unknown catalytic 
cause, in the total absence of any recognizable dis- 
ease. Like all other morbid poisons, it selects only 
a certain number of persons out of the whole popu- 
lation, and this without the slightest regard to the 
state of health the person is in at the time of expos- 
ure, as is made manifest by its attacking persons ill 
of fever at the various stages of the fever; regardless 
of the dyscrasic taints, such as syphilis, scrofula, 
phthisis, even persons under mercurial salivation; 
regardless of localities reputed to be healthy, cleanly, 
or otherwise, refuting the ceaseless and senseless cry 
against dirty and filthy places; regardless of the trade 
or calling of individuals; regardless of good or bad 
habits — among the latter drunkards, who, by-the-by, 
are proved by statistics to be more exempt than well 
conducted persons. 

216. Hitherto I have avoided speculation, called 
by some, theory, by others, hypotheses; but now, for 
once, will venture to offer what follows, not because 
I believe it is true, but because it may set some one 
thinking how the poison of cholera can operate. 



164 ASIATIC CHOLERA. 

Any one familiar with that part of organic chem- 
istry known under the name of Compound Elements, 
will readily conceive how a poison can be generated 
in the system, and being once formed in suitable 
quantity may exert a catalytic power, by its mere 
presence, over tissues which are in their natural state, 
and convert them from semi-solids into a liquid that 
shall ooze through the cutaneous and intestinal sur- 
faces, but not through serous membranes or through 
any of the other mucous surfaces, excepting the intes- 
tinal. 

217. Every one knows that a compound radical 
may be changed into another one, consisting of the 
same precise elements, and even of the same number 
of atoms, by the mere presence of a quite different 
body, which imparts nothing and abstracts nothing 
from the body it alters. The only thing it does is to 
alter the grouping of the old body to a new series of 
grouping in the new body its presence has brought 
about. Alcohol is converted into ether by the pres- 
ence of sulphuric acid; not a particle of the acid is 
given to either the alcohol or to the ether. Sulphuric 
acid, by its mere presence, converts starch into gum 
first, subsequently the gum into sugar, without com- 
bining with either, or losing a particle of itself. The 
same conversion of organic matter is effected by va- 
rious ferments. Many other examples of the power 



PATHOLOGY. 165 

of presence are well known, and that produced by- 
platinum is notorious* 

Knowing these facts, we cannot be surprised to 
hear it stated that the presence of the choleraic poison 
will rapidly convert the living juices and semi-solids 
of the body into a peculiar fluid, hitherto unknown, 
which has the property of transuding to and through 
the surfaces. 

218. Some writers have asserted that the gruel- 
like matter discharged was the fibrin of the blood; but 
the quantity discharged is greater than the amount 
of fibrin contained in the blood. On what imaginary 
ground this has been stated no one knows, nor can 
it be proved. No doubt fibrin, as well as other 
elements and parts of tissues, is converted into the 
new liquid, but there is no chemical operation that 
can prove the matter in question to be fibrin. It has 
none of the properties of fibrin, and all that chem- 
istry can do is to resolve it into elements which are 
common to all animal matter, healthy or otherwise, 
consisting of C. H. 0. N. 

219. To sum up what has been stated in this 
chapter, it appears that the human cosmogony, pro- 
portioned to the size of the system, has suffered a 
cataclysm, the greatest known. A portion of the 
constituent tissues are suddenly converted into a new 
fluid, an alarming colliquation is the result; the new 

8* 



166 ASIATIC CHOLEEA. 

liquid resists the confinement presented by the 
envelopes of the body, makes its way to the sur- 
face, escapes in profuse quantity, drains the body 
to dryness, and, in over one-third of the cases, to 
death. It is a colliquation not only of the living 
constituents of the body, but even of collections of 
matter that no longer form part of the system — such 
as dropsies — which are carried away out of their re- 
ceptacles along with the choleraic avalanche. During 
all this commotion the intellectual system sits serene, 
conscious of the revolution, but helpless. The newly 
created fluid has no taste to the patient, nor did it 
impart any to a few enthusiasts who ventured to 
swallow it; it is destitute of odor, although a choleraic 
patient produces in his room an indescribable faint 
smell, resembling that exhaled from water in which 
spinage has been boiled. 



CHAPTER VII. 

TREATMENT. 

220. A catalogue of remedies which have been 
used in cholera, asserted to have cured nearly every 
patient: 

1. Bleeding, cupping, leeching, arteriotoray, have 
cured, in the practice of one physician, eighty cases 
out of eighty-two. Infallible. 

2. Calomel, with or without opium, in grain doses 
every half hour — in four, ten, scruple, half drachm, 
drachm and two drachm doses, every half hour, in 
the practice of certain celebrities. Infallible. 

3. Emetics of mustard, ipecacuanha, emetic tartar 
in five grain doses, kitchen salt in water, frequently. 
All very beneficial. 

4. Pressure over the liver. Surely arrests vomiting. 

5. Purgatives of castor oil, Glauber's salts, Croton 
oil, aloes. Highly beneficial. 

6. Sedatives, as prussic acid, laurel water. Charm- 



ing. 



7. Enemas of hot water, spirits, asafoetida, tobacco, 



168 ASIATIC CHOLERA. 

spirit of turpentine, of brandy and water, Very 
beneficial. 

8. Stimulants. Brandy, sulphuric ether, carbonate 
of ammonia, creosote, strychnine, phosphorus, cacao- 
rum distilled over horse-dung, camphor, capsicum, 
horse-radish, garlic. Many cures, 

9. External heat. Warm baths, hot oats, hot sand, 
hot ashes, a warm skin fresh from a sheep. Did 
great good. 

10. Ice on the spine and back. Excellent. 

11. Astringents. Sulphate of copper, acetate of 
lead, nitrate of silver in pills, muriated tincture of 
iron, lime water with milk, extract of catechu. All 
beneficial. 

12. Drinks of brandy punch. Cured many, 

13. Acupuncture of the heart. Uncertain. 

14. Galvanism. Useless. 

15. Quinine cured like in ague. Good. 

16. Charcoal. A sovereign remedy. 

17. Subnitrate of bismuth. Phosphorus. 

18. External or revulsive applications. Scalding 
water, cantharides, strong nitric acid over the 
stomach, moxas, red-hot iron, heated hammers and 
laundry irons rubbed up and down the back. Pro- 
duced great effect. 

19. Laughing gas inhaled, oxygen gas inhaled, 
also drank in impregnated water. Useless. 



TREATMENT, 169 

20. Saline injections into the veins. 

21. Opium variously combined, etc., etc., etc. 

The foregoing list of heterogeneous remedies is 
not the production of quacks, but was seriously pub- 
lished, strongly recommended by practitioners of 
eminence, and who, to say the least, ought to have 
known better than to publish their conceits, and 
ought now to blush at their errors, 

221. If ever humanity were entitled to pity for 
sufferings created by errors, the growth of a false 
science, it is surely in the case of cholera, as a glance 
at the remedies and treatment employed mentioned 
in the foregoing list would indicate. Yeryfew prac- 
titioners have had the conscience to avow that they 
were at a loss what to do, and had also the courage 
to resist the importunities of interested persons 
urging them to "do something." A majority of 
practitioners went to work in a case of cholera 
trying one thing or anything; and should the patient 
survive both the pest and the remedy, they would 
hasten to publish a cure effected by an infallible 
mode of treatment. After repeated failures, they 
would jump to another means as senseless as the first 
one; and now, forgetting the late asserted cures, 
proclaim the last one infallible also ! In this way 
has the profession been disgraced. 



170 ASIATIC CHOLERA. 

222. It is easy to perceive, through the mist rising 
from the catalogue of remedies just cited, where lay 
the root of a false medication. The mind of a student 
receives a bend suited to nosology, the symptoms and 
treatment as laid down in books, and which he finds 
confirmed by a most imperfect, coarse and erroneous 
physiology, grown out of a mixture of descriptive 
anatomy and shallow chemistry. Thus endowed he 
feels himself ready to combat any disorder, and that 
he is armed with a knowledge of every thing per- 
taining to medicine — known and unknown. He 
never once notices the conflict of dogmas that cease- 
lessly rise up in his path, unless it is to reconcile or 
refute them, always to his own satisfaction, and 
never to that of a co-laborer. He has the faculty of 
argumentation. When he is at a loss for a method 
of treatment, he soon finds one, founded on analogies, 
whether the supposed analogy suits or not. Hence 
the wild range of his fancy, to which he bows with 
complacent respect, adapts something to suit some- 
thing, right or wrong; who is to judge? Not the 
patient, or if he or others do, his acquired facility 
of argumentation and explanation will carry him 
through in triumph, to his own satisfaction, if not to 
that of others. 

Thus armed, he attacks cholera as he would disease 
as described in nosology, not once dreaming that 



TREATMENT. 171 

nosological disease does not exist in cholera. He 
brings a treatment founded on analogies, but which 
do not exist in reality in cholera. His patient 
vomits — he administers carminatives, to soothe a 
stomach that is not disordered in itself; his patient 
has profuse purging, when the purging treated of in 
nosology does not exist — he adminsters astringents; 
his patient transpires profusely — this he dare not 
attack, for now he is confused; the heart and pulse 
are feeble, the latter extinct — he prescribes stimu- 
lants to organs that cannot be roused by stimulants; 
his patient is cold — he will apply external heat that 
cannot penetrate to the interior; the stomach is still 
irritable — he will apply revulsives where metastasis 
cannot take place; he will excite a " new action in 
the system" founded on the theory that two diseases 
cannot exist at the same time; he gives calomel for 
this purpose, a substance which is perfectly inert in 
the actual and wonderful state of the system. 

223. Let us now do as was done with the symp- 
toms, examine them in detail, and the treatment and 
remedies, each by itself, and discover, if we can, the 
discrepancies we shall meet with. 

Abstraction of blood. When contagious cholera 
broke out in India, the prevalent idea of the nature 
of the disease was, if not inflammatory, there was 
at least congestion somewhere. At that time bleed- 



172 ASIATIC CHOLERA- 

ing was the battle-horse, and often had recourse 
to, if only for fashion's sake. Accordingly we find, 
in the first years of the pestilence, almost every prac- 
titioner drawing blood, urging the practice in publi- 
cations, and citing numerous cures, They advised to 
bleed to the extent of thirty ounces, if that quantity 
can be had; if not, get as much as you can; and as 
the blood soon becomes thick and flows with reluc- 
tance, open the vein as early as possible, while the 
heart has still power to act, and the blood not too much 
inspissated to flow. If phlebotomy gives no blood, 
apply cups; if cups give none, try leeches; if all these 
fail, try arteriotomy. Some practitioners declared 
that under the sanguinary treatment they cured nine 
out of ten cases; others cured nineteen out of twenty; 
and Dr. Barrel eighty out of eighty-two cases, all by 
bleeding! Other practitioners were less fortunate, 
soon saw the error and opposed it; but still the prac- 
tice prevailed for several years, even until the pest 
reached Europe in 1830, and after, by those routinists 
who can never get out of a beaten track. 

224. We find, from the very beginning of an attack 
of cholera, that all venous capillary action is greatly 
arrested, if not quite stopped, and that the vigor of 
the heart diminishes rapidly. The volume of blood 
is soon reduced by the oozing out of the serum and 
much of the fibrin, leaving the globules behind. Can 



TREATMENT. 173 

bleeding arrest or restore the loss, or re-establish the 
natural proportions of serum, salts, fibrin, and the 
quality of the globules ? No. Besides, blood, like the 
tissues, is subject to the colliquative force of the poi- 
son, and is itself inert, receives nothing, communicates 
nothing, and of course is a passive body. Hence it is 
that inflammation has never been excited, and cannot 
be kindled by any amount of irritation during the chol- 
eraic stage. Will bleeding, then, arrest an inflammation 
that cannot and does not exist ? Absurd. Experience 
has at last forced the advocates of bleeding, and the 
routine practitioners, to abandon this gross error. 

225. Calomel is the next heroic remedy, which, in 
India, appears to have been, as it were, a household 
necessity, to be administered in every and all kinds 
of disease. Given as a mere laxative, as a depurative 
of bile and other humors, or with a higher view, under 
the theory of inducing a change in the constitution 
for a time by establishing a new disease, which is to 
supplant the first one and expel it, under the dictum 
that "two diseased actions cannot exist together." 
Leaving the theory to defend itself, let us endeavor to 
ascertain whether there exists the remotest or slight- 
est probability that the drug can be absorbed into the 
system; if not, it must prove useless. When practi- 
tioners had recovered from the alarm and confusion 
of ideas, and commenced slowly to observe the phe- 



174 ASIATIC CHOLERA. 

nomena produced by the poison, it was discovered 
that absorption was completely arrested; consequent- 
ly, calomel might be conveyed into the stomach, but 
could not enter the system. Besides, it was moreover 
discovered that circulation was also arrested; so that, 
if even mercury were absorbed, it could not be car- 
ried through the system. So potent were a wrong 
education, a defective physiology, a badly acquired 
habit, a blind faith in false doctrines, and a perni- 
cious obstinacy in adhering to habit, that almost all 
physicians made use of calomel. One gave a grain, 
with or without opium, every half hour; another two 
to five grains; finding these doses inefficient, ten to 
twenty grains; others, bolder, gave half drachm, one 
and two drachm doses. Should one or two patients 
out of three (the average number) recover, the recov- 
eries were boasted of as cures. For a long time the 
small dose, the medium, and the heroic dose doctors 
published how successful was their practice. In time, 
however, this abuse of calomel declined, but is not 
yet extinct among that numerous class of practition- 
ers who cannot rise above the grade of routinists or 
mere medicasters. 

226. Metastatic treatment. The theory of metas- 
tasis, an ancient one, not altogether false, is still 
prevalent, and comes as a kind, too often a cruel aux- 
iliary to the practitioner who, when at his wit's end 






f&EATMENT?. 1*75 

for means, calls in the aid of his friends — revulsives — 
in the hope that they will translate a malady to the 
surface, if not quite, yet in some proportion. To 
leave nothing undone, even when nothing can be 
done, sinapasms, cantharides, cauteries, and every 
imaginable means capable of irritating and injuring 
the surface, have been employed without stint, When 
employed early, which is rarely the case — that is, 
before the surface has become quite cold and the 
capillaries stagnant, as announced by cyanosis— these 
means may act slightly on the skin, for a very short 
time, should the case be a slow one; soon, however, to 
be arrested, as all other actions are, by the cataclysm 
induced by the poison. But in most cases the length 
of time claimed by all epispastics to act is longer than 
the collapse will permit, and vesication, if useful, can- 
not take place. Why, then, torment the patient with 
them? 

227. A more energetic metastatic means has been 
had recourse to — scalding water, as an instantaneous 
means; red-hot iron, by French practitioners indoc- 
trinated to this cruelty by the combustible old Larrey; 
also his moxas; by the Germans, such delicate instru- 
ments as burning-hot hammers and laundry irons 
promenaded down each side of the spine and back; 
strong nitric acid applied over the stomach ! Was I 
wrong when I said the choleraic were entitled to 



176 ASIATIC CHOLERA. 

pity for the sufferings inflicted by dogmatic practi- 
tioners? It is fortunate for the victims of such mon- 
strous cruelties that none recovered to endure the 
protracted suffering that wide-spread sloughing 
would induce. If any of these patients recovered it 
is unknown, and the heroic doctors have kept silent 
regarding the ultimate destruction that th&ir bar- 
barity must have created, had it been possible for 
man to resist the first effects. Yet many of the 
medical heroes had the hardihood to declare that 
their treatment was good, and did cure. 

228. Emetics to arrest vomiting. The signal ben- 
efit of an emetic in cases of saburra, and at the com- 
mencement of fevers, suggested, no doubt, the idea of 
" clearing out the stomach," and in this way remove 
peccant matter, which caused the vomiting. Had 
the majority of remedies administered in cholera 
been as reasonably founded on derived experience, no 
great censure could attach to the practice; but, un- 
fortunately, the peccant matter is renewed as fast as 
it is ejected, and as long as the system can furnish 
material for colliquation; but the case bears no an- 
alogy to those in which emetics are useful. 

Tartrate of antimony was one of the forms of 
emetic employed and praised, given in five grain 
doses, repeated. Such a dose is astounding, and 
finds no place in practice, excepting in the Italian 



TREATMENT. 177 

practice wherein it was so administered, not to clear 
the stomach, for such a dose does not excite vomit- 
ing, but to produce such an arrest of circulation and 
nervation (the new word is innervation) as will sub- 
due pleuritic inflammation, against which it was em- 
ployed with benefit. But cholera is neither pleuritis 
nor other inflammation, nor a disease, as has already 
been explained. Ipecacuanha, mustard, and kitchen 
salt, frequently repeated, although an erroneous prac- 
tice, is not deleterious and astounding like antimony. 

229. Pressure over the liver, to arrest vomiting, 
was recommended, with what effect is not mentioned, 
nor on what principle is it possible to imagine — 
although in this instance, like in many others, there 
are metaphysical abstractionists who are ever ready 
to explain any thing, if it be only absurd enough. 

230. Purgatives were had recourse to and recom- 
mended. They could do no other harm than what is 
due to the annoyance of swallowing them and their 
immediate rejection upward, adding to the distress 
of the patient and increasing his exhaustion. But, 
were it possible for the purgative to lie on the stom- 
ach and reach the intestinal canal, it could not come 
in contact with the mucous membrane, which is in a 
ceaseless state of oozing, a state that will protect its 
surface from the remedy; besides that, as all physio- 
logical action is here arrested, a purgative, even 



178 ASIATIC CHOLERA. 

could it reach the mucous surface, would not excite a 
purgative secretion. 

Castor oil, aloes, Glauber's salts, Croton oil, ox 
gall, were the purgatives employed. 

231. Antispasmodics were called into service — on 
what ground no rational mind can conceive; but the 
practice can be defended and explained by routinists, 
who have the faculty of explaining things known 
and unknown, right or wrong. Among these reme- 
dies are, or were, musk, cajeput oil, guaicum, asa- 
fcetida, hartshorn, valerian, or any thing that has a 
bad odor. 

232. Sedatives — Prussic acid, laurel water, opium; 
but of this last see hereafter. 

233. Enemas — not able to do good per oram, some 
practitioners descended ad infra to operate per 
anum. Accordingly, enemas containing asafoetida, 
castoreum, spirit of turpentine, alcoholic spirits, 
even tobacco, have been recommended and used; and 
fortunately the tobacco has been rejected as soon as 
injected, else it would add a new collapse to that 
which the patient can no longer bear up against. 

234. Stimulants have been largely had recourse 
to, and might, by judicious management, prove an 
auxiliary to other means; but they require a most 
careful watching. Sulphuric ether alone, and with 
ammonia, carbonate of ammonia in five grain doses, 



I 



TREATMENT. 179 

creosote, strychnine have been given; phosphorus 
also — here I must stop a moment to say what I have 
seen done with phosphorus. It was recommended in 
the Edinburgh Journal to give pills of phosphorus, 
made by beating phosphorus and bread-crumb under 
water into a mass and making it into pills. An old 
gentleman caught the idea, made some and gave them. 
His son, a dashing new light, disdained trammels, 
saw no necessity for following the laborious method 
of his father, but attained the same end by simply 
cutting sticks of common phosphorus into chunks. 
He carried these pieces with him in a vial in water. 
As I was passing a house in a garden, a woman 
standing at the gate asked me to walk in and see 
her husband, Wm. Harrison, sexton to the English 
burying ground. I found him in collapse, quite sen- 
sible. The young doctor followed me in, who, with- 
out ceremony, said, " My dear fellow, 111 cure you at 
once. Open your mouth; 111 poke these pills down 
your throat — theyll cure you." Accordingly he 
took out of his bottle about ten pieces of phosphorus 
of at least two grains each, which he did " poke" 
into the pharynx. How the remedy acted I did not 
stay to see; but he died a few hours after. This 
man had gone unscathed through the whole of 1832, 
and was daily at work conveying dead to the ground 
and burying them. He passed through the greater 



180 ASIATIC CHOLERA. 

part of the cholera of 1834, but was attacked August 
7th, died the same day, aged 54. 

Opium with camphor, opium iu large doses, recom- 
mended by Dr. Tweedie, who ought to have known 
better, and who at last said while it did good it 
hastened death. Camphor, capsicum, horse-radish; 
brandy alone will cure, said Dr. Leo, of Vienna ; 
especially cacao-brandy, distilled over horse-dung, 
called Tangara. Dr. Kiven's infallible Vienna reme- 
dy, which cured all but two out of 242 cases, was com- 
posed as follows : one pint of spirits, half a pint of 
vinegar, one ounce of camphor, two drachms of pep- 
per and one ounce of garlic — a teaspoonful to be taken 
frequently. 

Practitioners who have a predilection for stimulant 
medicines of a carminative class, such as sulphuric 
ether, might, perhaps, substitute chloroform in five to 
ten minim doses in a little water, internally, since it 
is agreeable to take, and as good a stimulant as ether. 
But not by inhalation; for, should it permeate the 
lung-tissue, which, in cholera, is not likely, it would 
tend to paralyze the heart in an additional degree. 
Besides, chloroform in the stomach, like carbonic acid 
gas, produces the opposite effect to what occurs in 
inhalation. 

235. Warm baths, also dry heat afforded by hot 
oats, hot sand, hot chalk in powder, hot ashes, and, as 



TKEATMENT. 181 

a contrast of consistency, ice on the spine, and cold 
baths, 

236. Astringents. Sulphate of copper, by no less 
a character than the great Dupuytren, nitrate of sil- 
ver in pills, acetate of lead, muriated tincture of iron, 
lime water and milk, magnesia, subnitrate of bismuth 
in four grain doses, extract of catechu. 

237. Drinks. Warm water, cold water, ad libi- 
tum; by others, none at all; brandy, pure or as punch; 
effervescing draughts. 

238. Acupuncture of the heart, by Dr. Searl, at 
Warsaw, one of the commission sent thither to in- 
quire into the pest and report upon the best treat- 
ment. He was, of course, a respectable practitioner, 
but this conduct proved him to be a crazy man; by 
the same, galvanism; he, however, says, correctly, that 
this last is of no service. 

239. Quinine, per or am et anum, has been ad- 
ministered by routine practitioners, who had not 
strength to move out of the beaten track of nosology, 
and who compared an attack of cholera to one of 
ague, supposed that the collapsed state was the cold 
stage, and the weak attempt of nature to recuperate, 
called the typhoid state, was the hot stage. What 
can be done with such minds ? Quinine was also given 
in enemas when it could not be retained, and even 
injected into the veins. 

9 



182 ASIATIC CHOLERA. 

240. Charcoal made from burnt corks is reported 
to have been used on board of a United States frigate 
in India, most likely as an antiseptic. This idea was 
caught up by an extraordinary man, poor, philan- 
thropic, ignorant and zealous. He appears suddenly 
in Montreal, soon after the outbreak, accompanied 
with his inseparable companions — a lean mare and 
two grown-up colts; these followed him wherever he 
went, like docile dogs. His services were gratuitous, 
kind and modest. In a short time he was looked 
upon by the poor as a saint from heaven, and got the 
name of Saint Eoch. His remedy was equal parts of 
powdered wood charcoal, hogs' lard and maple sugar. 
Of this disgusting medley was to be taken as much as 
could be swallowed; an addition was made, consisting 
of a pailful of cold water and wood ashes, with which 
the feet and legs were bathed. This lye he rubbed, 
or caused to be diligently rubbed into the skin, as 
high up as to the knees. I saw him at work in the 
case of a tall, lean old man, whose skin over the tibia 
appeared to be dissolved and rubbed away. This 
man was a wealthy and respectable publican, George 
Wurtele, about sixty years of age. He sat in a chair 
during the treatment, quite conscious, and died the 
same day, after a few hours' illness. 

241. Oxygen gas was had recourse to, suggested 
by the absence of aeration of the blood. It was both 



TREATMENT. 183 

inhaled and drank in water saturated with it, also in 
saturated water injected into the rectum, but proving 
of no avail, was soon abandoned. Nitrous oxyde 
gas was used in the same way with the same results. 

242. In 1848 chloroform was administered, inter- 
nally, with beneficial effect, I was told; but of myself 
I have no knowledge of its use. 

243. Saline venous injections. The able and 
graphic description of a case of cholera by Dr. 
O'Shaughnessy, and his analysis of the blood and dis- 
charges, led to his first suggestion of the injection of 
a solution of nitrate or chlorate of potash, as being 
highly oxygenated salts and likely to act on the 
globules; but it does not appear whether or not it 
was put into practice. Dr. Clanny, of Sunderland, 
also threw considerable light on the chemistry of 
cholera. But the first one to avail himself of inject- 
ing salts into the veins was Dr. Latta, of Leith, 
Scotland. His solution was composed of chloride 
of soda, two drachms, carbonate of soda, two scru- 
ples, white of egg, and water, four pints. He in- 
jected in the beginning of his operations from five to 
ten pounds, repeated at short intervals; but seeing 
the impunity with which this foreign matter could be 
introduced into the vessels, he grew bolder, until he 
and many others injected, without stopping, 330 
ounces in the space of twelve hours. Thirtyone 



184 ASIATIC CHOLERA. 

pints were injected into a patient in the space of 
three hours. As much as six hundred ounces have 
been injected at a temperature of 112°, 116°, 124°, 
but oozed out cold^er eutem et anum. However, it 
was soon ascertained that it gave no permanent 
benefit. 

244. The effect of the injection was of the most 
marvelous character, and often struck non-profes- 
sional beholders with awe. A patient lying in the 
collapsed state, lean and cold, and often manifesting 
no consciousness, moribund, would, as the injecting 
progressed, gradually fill out, improve in color, open 
and shut the lids, and sometimes speak. Dr. Tweedie 
mentions three wonderful cases, which, after being 
resuscitated, as it were, got up, conversed jocularly, 
but all at once fell into collapse again and suddenly 
died. 

245. Transfusion was in some cases added after 
the saline injection, but no good came of it. 

The idea of injecting salines was with a view to 
oxygenate the blood, and on that account O'Shaugh- 
nessy suggested highly oxygenated neutral salts; but 
Latta employed carbonated salts, and others fol- 
lowed his example — yet the effect was marvelous. 
Soda or any neutral salt will redden the blood. 

246. Personal experience. I shall cite only two 
cases out of many. A chambermaid, a beautiful girl, 



TREATMENT. 185 

much admired for her plumpness and fine color, 
about twenty years of age, lived at the Brock Hotel, 
Montreal. While in the cyanosed and collapsed 
state, lean and shriveled, especially the fingers and 
hands, but possessed of her senses, Dr. Stephenson 
injected into the basilic vein of one arm five or 
six pints of saline fluid ; gradually her face filled 
out, her cheeks became once more rosy, her dry 
and sunken eyes became moist and bright, and less 
deeply sunken into the orbits; her voice became less 
husky — altogether she seemed restored, but a shiver- 
ing came over her and she soon died. This was the 
first case I saw. 

247. Another case. I was invited to see Drs. 
Arnoldi, Senior and Junior, inject Mr* Oliver Wait, 
on Sunday, at noon, August 21st, 1832. He was 
about forty-five years of age, a very strong and mus- 
cular man, much given to daily active exercise in the 
open air. I found him lying on his back, apparently 
dead, excepting the quiet respiration manifested by 
the slow movement of his chest. Vomiting, purging, 
and oozing out by the skin had completely ceased; 
his skin was cold, leaden color, but that of the face, 
tanned by habitual exposure, was rather brown than 
blue; his face was now sharp and lean; his eyes deep 
sunken in the orbits ; the lids partly open and 
immovable; the eye was quite dry and the cornea 



186 ASIATIC CHOLERA. 

flattened; his mouth was slightly open; house flies 
crawled in and out of the lips, into the nostrils and 
out, and over the exposed part of the eyes, without 
exciting the least perceptible winking. Such was his 
state when the old doctor had finished making two 
large wash-bowls of saline fluid, and his son had 
inserted the tube into the basilic vein of his left arm. 
All being ready, the old gentleman said to me, " You 
do not countenance this treatment; here is an extreme 
case; you shall soon see him restored." He com- 
menced to inject by means of a Reed's pocket brass 
syringe, capable of discharging about twelve drachms 
at a stroke of the piston. He worked on deliberately 
and ceaselessly until the first bowlful was nearly used 
before any apparent effect became noticeable; at last 
the color of the cheeks became lighter, the face looked 
a little fuller, and the malae less prominent; next, 
the eyes became moist, and much less dim, but the 
lids did not move ; his respiration was regular 
as heretofore, but much more expanded. At the 
last of the second bowlful the lids opened com- 
pletely; he stared at us, but did not wink, nor did 
he make the least motion, nor attempt to speak; his 
skin grew moist, but remained cold, although the 
injection was at 112 p ; and at last we heard a gush 
from the bowels, soon followed by an exceedingly 
strong rigor. The young doctor exclaimed: " We have 



TREATMENT. 187 

established the ague stage; send for quinine I" In a 
few moments more he ceased to breathe, and was 
dead. 

The moribund state of this strong man before the 
injection and his sudden apparent recovery, gave to 
many of the bystanders the idea of a ghostly resurrec- 
tion of a corpse; some of them left the room in terror. 
In me it excited the sentiment of a total refutation 
of the doctrines of physiology — a dead man brought 
back to life, as it were, by merely filling the vessels 
with a fluid not natural to the body. The heart was 
once more set agoing, and a feeble pulse could be felt 
at the wrist; the mind once more restored — some 
thought. Can a recently dead man be restored to life 
— at least, will these experiments be improved upon 
and made available in disease ? 

248. Having completed a critical review, I hope 
with candor and honesty, of most of the remedies and 
modes of treatment recommended in cholera up to the 
period this sketch treats of, that is, to 1834, 1 have 
only to add one advice — look at the heterogeneous 
kinds of incompatibles in the quoted catalogue, many 
of them still in use, each opposed to each, and nearly 
all useless, often injurious ! 

It is with a faint pleasure I come to notice and 
remark upon another class of remedies that do not re- 
volt our common sense, and which have proved to be 



188 ASIATIC CHOLERA, 

great auxiliaries to nature — in many cases have con- 
tributed a fair share towards the recovery of some 
patients, and, when judiciously employed, injurious to 
none. 

249. Opium, first of all. Sydenham said: " With- 
out opium, all medication would be imperfect and 
insufficient." Its effect is often decisive of life or 
death; used at the critical moment it will save, and 
as surely will destroy if wrongly applied; is unique 
in its operation, and cannot be replaced by any other 
remedy; has reigned for more than a thousand years 
despot over the medical world, and spread benefits as 
well as ruin over humanity; it is a double-edged 
sword, a divine gift in the hands of a master, a poison 
in those of a mere routinist — a medicaster — a demi- 
physician. Sacra vitce anchor a, circumspecte agenti- 
buSj est opium; cymba zero Charontis in manu im- 
peritiP 

Throughout the whole reign of cholera opium has 
been had recourse to, with benefit when judiciously 
employed; but which, alas, has seldom been the case, 
for there are only a few practitioners who are deeply 
versed in the recondite action of this heroic remedy 
while the great majority see in it only an every-day 
drug, and are totally ignorant of its mysterious power. 
This is a severe judgment, but, unfortunately, a true 
one. In describing common cholera, Sees. 92 and 96, 



TREATMENT. 189 

97, 98, passim, I there endeavored to explain how 
opium, only one grain, was sufficient to arrest that 
complaint. 

But first let me make one admonition on the prep- 
aration. When a practitioner has serious work on 
hand, let him use the simplest means as being the 
most sure to reach the end he has in view. In all 
serious cases where real work is to be done, employ 
pure opium. Nature has made it perfect. She is the 
greatest and wisest chemist, with whom no one can 
compete. Pure opium contains a well balanced mix- 
ture of homogeneous ingredients, the removal of one 
of which will proportionately deteriorate the article. 
Pharmaceutists have tortured opium in all possible 
ways to improve on that which comes perfect from the 
hand of nature, and by their scandalous puffing have 
imposed on weak minds, ever on the qui-vive for some- 
thing new; in cases of cholera, abandon, then, all fancy 
forms of opium — black drop, elixirs, and the various 
salts of morphine, codeine, narcotine — all the Hues. 

250. In Asiatic cholera, a small dose of opium, not 
over one grain, given after vomiting has continued 
long enough to reject the new and noxious matter 
poured into the stomach, will calm the irritability of 
the organ, and save the patient from the debilitating 
efforts at vomiting, no longer needed, A larger dose 
might so paralyze the stomach as to arrest its power 
9* 



190 ASIATIC CHOLERA. 

of ejecting what ought to be discharged, and lock it 
in, to the injury of the patient. Should the dose be 
rejected, take a moment of repose and give another, 
dry, if possible, so that the volume may not offend a 
preternaturally excitable organ. Should this dose be 
retained, in fifteen or twenty minutes after some 
agreeable acid drink, mentioned hereafter, may be 
given, an ounce at one time; this being retained, re- 
peat it, and increase the quantity and the frequency 
of repetition compatible with the powers of retention. 
To give oftener or more at a time before the stomach 
will retain it will frustrate the object sought. 

The real use of opium here is simply to quiet the 
excessive irritability of the stomach, and arrest the 
frequent vomiting, the efforts of which tend greatly 
to add to the exhaustion of the patient. Opium has 
been combined with aromatics, stimulants, such as 
ether, ammonia, etc. It is doubtless good, but the 
volume of the dose is greater than the viscus will en- 
dure, and will be rejected. Give the opium dry. 

Opium has been given in repeated doses, every 
half hour, regardless of a stomach filled with poison- 
ous matter which vomiting must discharge, and hav- 
ing succeeded in paralyzing the organ, has tended to 
a speedy death. Before deciding on the administra- 
tion of opium, one important consideration must be 
carefully borne in mind, that is, what is the cause of 



TREATMENT. 191 

the Tomiting? Let us examine this point. It is cer- 
tain that previous to the attack the stomach was in 
no way disordered; therefore, something has hap- 
pened to disturb it; what is this something? Evi- 
dently, newly created choleraic matter poured, or 
rather oozed, into the stomach, which offends it, and, 
like all offensive matter in the stomach, vomiting is 
the remedy nature employs to rid the organ of what 
is noxious. As this matter cannot all pass the pylo- 
rus into the intestines it will be rejected, and must 
be got rid of, to a great extent, before it will be pru- 
dent to give opium and thereby arrest the rejective 
power of the organ. In the early period of the col- 
liquation the noxious matter is rapidly oozed into the 
stomach, but after a while there is less and less of it 
so furnished, while the organ once offended continues 
to act when none or little remains; it will act when 
all choleraic matter has ceased to be present; if only 
water be admitted in a quantity greater than the in- 
duced irritability will endure, this will be rejected. 
It is this persistent irritability that opium is em- 
ployed to allay. 

When opium is administered at the proper time, 
and in proper quantity, it will not only allay a state 
of vomiting, which is no longer needed, but it will 
also soothe the whole economy in a notable degree, 
and pave the way to a recovery. Would it be safe 



192 ASIATIC CHOLERA. 

to inject the opiate hypoderaiically in cases of such 
great irritability of the stomach that much difficulty 
to retain the medicine on the stomach is experi- 
enced ? But it must be borne in mind that the ob- 
ject is to arrest useless vomiting; therefore, the 
quantity injected ought to be very small. 

251. Water, cold water, is the ceaseless cry of the 
patient from almost the first onset of the case. This 
thirst is not due to fever, or any thing like fever, for 
fever does not and cannot exist in cholera; it is due 
to two causes — a perverted sensation of heat, like 
that of the skin, and to the great drain which has 
dried up the tissues, as it were. During the early 
period of the complaint, while vomiting is active, 
produced by the presence of the new matter, let the 
patient take as much as he calls for; it will be re- 
jected, of course, but will not increase the vomiting. 
However, when the colliquation becomes diminished 
or exhausted, care must be had in mind that now 
the vomiting is continued from induced irritability 
after the exciting cause has ceased to act. 

252. Brinks are loudly called for, and might be 
given under the conditions already mentioned, were 
it not that they are useless in the early period of 
the complaint, since they cannot be absorbed or cir- 
culated, as elsewhere noticed. There is, however, 
one beverage — doubtless there are others — which I 



TREATMENT. 193 

have found grateful and useful. It may be called a 
lemonade, made of sweetened water acidulated with 
tartaric acid, in the proportion of half a drachm to 
a tumblerful. But it must be given with much judg- 
ment, so as not to offend the stomach by volume. I 
had previously tried nitric acid, but it proved offen- 
sive. "When phosphorus was suggested as needed by 
the system, I bethought myself of substituting phos- 
phoric acid for tartaric acid, but being satisfied with 
the latter, I did not put the phosphoric idea into exe- 
cution. 

253. Phosphorus has been prescribed as stated, 
Sec. 234 — upon what principle I cannot imagine. 
The common stick phosphorus is exceedingly unman 
ageable, and on this account I would recommend to 
those who believe in its utility to try amorphous phos- 
phorus, which is quite manageable and pleasant to 
take. 

254. Hot applications have already been men- 
tioned, and are useless, besides being an annoyance 
to the patient. Experience shows that a patient can- 
not be warmed by external means, and the large 
amount of hot saline injections into the veins has not 
contributed to the warmth of the patient. Aeration 
of the red part of the blood is the means employed 
by nature. 



194 ASIATIC CHOLERA. 

255. Cold applications. I knew one case of cold 
bathing. A poor man had just lost his wife from 
cholera, when he himself was attacked, and, like all 
others, suffered from a feeling of heat; he found his 
way into the yard, got into his water-barrel, re- 
mained in it some twelve hours, when, feeling re- 
lieved, he got back into the house nearly recovered, 
when he found his dead wife where he had left her. 

256. The foregoing analysis of the various rem- 
edies and modes of treatment employed in cholera 
show clearly that the authors were at a loss what 
to do, and quite bewildered; and that no correct 
opinion existed regarding the immediate cause, nor is 
that uncertainty yet removed. Let us turn and be 
honest, cease our pretensions to a knowledge that we 
do not possess, discard the foregoing errors, and by so 
doing disembarras ourselves of a false, useless and of- 
tentimes injurious medication, and commence anew. 
Let us throw theory overboard as useless now, and 
try instead a reasonable, empirical and an expectant 
treatment, until, little by little, we arrive at some- 
thing that can be relied upon. In this way we shall 
do no harm, and not hurry the patient to his end, as 
has too often been done. We still meet with prac- 
titioners who assert boldly that cholera is quite 
manageable, and boast of the many cures they have 
made. 



TREATMENT. 195 

257. Dialogue. You deceive yourself, Doctor; 
neither you nor any one else has ever cured a case of 
cholera. 

Yes, I have cured many; I can prove what I say* 
There is Mr. — and Mrs. — , and many others, who 
were very ill; I cured them, and they are now alive, 
and will substantiate what I say. 

No doubt you had such patients; that you attended 
them, and that they are alive to day; so far true: but 
how many cases have you had, and how many of them 
have survived ? 

I have cured nearly every case — at least nineteen 
out of twenty. 

It is likely that you trust more to memory than to 
a correct list of your cases and alleged cures. All 
history, on which the slightest reliance can be placed, 
and respect accorded, shows that the most favorable 
result has been the recovery of two in three cases; 
one-third of the attacks have died. There are 
instances of one-half, even of two-thirds, of the 
attacks ending fatally in a few places invaded. If 
you can be persuaded of your error, you will, on a 
future occasion, judge with more accuracy than you 
now do, and be in a better state of mind to benefit 
a patient than heretofore. 

258. Expectant treatment aided by an enlightened 
empiricism. Before deciding on a method of treat- 



196 ASIATIC CHOLERA. 

ing a case of cholera, we must make up our mind 
regarding the nature of the complaint — that is, the 
immediate mode in which the poison acts. It has 
been shown (Sec. 210) that this mode of action is 
one that converts a portion of the body into a liquid 
form, and that the liquid so created will ooze through 
the tissues and out of the body by way of the intes- 
tinal, mucous and dermoid surfaces. Whether the 
liquid which escapes existed in the tissues already 
formed before it reached the surfaces, or that it put 
on the liquid form on arriving at the surfaces, is uncer- 
tain; but in any case, having arrived there, and been 
poured into the alimentary canal, it must not be 
locked up therein by any medication we may employ, 
should we possess a medicine capable of arresting its 
discharge. There are well authenticated cases in 
which no discharges have taken place, unless it is that 
which escapes by the skin. In such cases it is evi- 
dent that the colliquated matter has not entered the 
stomach and intestines, but is retained within the 
tissues; perhaps it did not go through the necessary 
phases that precede the liquid form. However this 
may be, it is of little importance, in a medical point 
of view, since all such cases are mortal and cannot 
be helped by medication. 

259. A practitioner seldom sees the commence- 
ment of a case, unless he should happen to be near 



TREATMENT. 197 

the person attacked. When such an opportunity 
occurs, the first complaint of the patient is that he 
feels an indescribable feeling of general uneasiness — 
something wrong at the stomach — a mawkish sensa- 
tion, and a rapidly increasing debility. He has a 
call to stool, which he obeys; a large motion escapes, 
unaccompanied by any pain in the bowels or the 
least feeling of colic. He has scarcely relieved the 
bowels when he feels another call and has another 
motion, succeeded by another, and so on. He now 
begins to experience some thirst and a pasty mouth, 
destitute of taste, soon followed by vomiting; a damp 
skin, which is cold to another, but not to himself, and 
which he soon complains of as being hot. Such were 
the feelings of the author when he was attacked at a 
time when he was quite well, in the forenoon. In 
general a doctor does not see his case until it has 
advanced to rapid purging, vomiting, cyanosis and 
cold surface. 

260. Meeting with a case in this stage, the first 
prescription must be to inculcate as much quietude, 
or cessation of that tossing about from side to side 
on the bed, as the patient can be prevailed on to 
maintain, for such movement of the body increases 
the peristaltic action of the bowels and the vomiting. 

261. "While vomiting of choleraic matter con tin* 
ues, there can be no objection against allowing the 



198 ASIATIC CHOLERA. 

patient to drink moderately, some say freely, of what 
he so ardently calls for — cold water; for, whether 
he drink or not, he will vomit as long as the stomach 
receives choleraic matter into it, and which ought to 
and must come away, as very little of it will pass 
into the intestines and escape by that canal. It is on 
this account that some practitioners have advised 
emetics, but of which there is no need, since the mor- 
bid matter is an emetic of itself. As the colliqua- 
tion does not last long, the oozing into the stomach, 
at first rapid and in great quantity, soon diminishes 
and but little will remain after the vomiting will 
have continued for a while; but the irritability it has 
set up in the stomach will continue when little or 
none remains. This irritability is so persistent as to 
force the stomach to reject even the water it so much 
craves, and which it cannot endure the presence of, 
even in a very small quantity. 

262. It is now time to administer the opiate, to 
calm a useless irritability which excites efforts to 
vomit when the need and the good of vomiting has 
passed away, and which, if allowed to go on, will 
greatly add to the prostration — the patient already 
exhausted. Give, then, the opiate in moderate dose, 
not more than a grain (Sec. 250); if it stay down for 
only ten minutes it will have, in that short space of 
time, diminished the irritability, to a proportionate 



TREATMENT. 199 

degree, and tend to its remaining fifteen minutes, 
perhaps to continue down. Should it be rejected, 
repeat the dose. When this is well conducted, per- 
fect stillness observed, even of speech, on the part of 
the patient and the bystanders, one dose, at most, 
will suffice to calm the organ and soothe the whole 
system. When this is established — say in half an 
hour — we may venture to give a tablespoonful of 
water or tartaric lemonade; in a few minutes more 
repeat this quantity, gradually increasing the quantity 
with caution and judgment, so as not to set vomiting 
once more agoing by the presence of a volume which 
the stomach will not endure. In a short time more 
the patient can be safely supplied with as much as is 
good for him, but never more at one time than three 
to four ounces at a single draught. 

263. A larger quantity of opium than what has 
been recommended will overdo and paralyze the de- 
bilitated stomach beyond a safe point. As soon as 
it is ascertained that the stomach will bear it, a cup 
of good broth or beef tea may be added, and in time 
other appropriate nutriment. 

264. Diarrhoea, previous to an attack of cholera, 
or cholerine, as it has been called. It is doubtful 
whether or not this affection of the bowels is really 
an antecedent of cholera, or that it is not either an 
ordinary looseness so commonly met with at all times 



200 ASIATIC CHOLESA. 

when no cholera prevails, or in many cases is the 
result of mental anxiety, disturbing the bowels in a 
time of great general alarm, may be questioned* 
This doubt is strengthened by the facility with which 
the feculent discharges can be suppressed and no 
cholera follow, also by the fact that this diarrhoea 
may last several days and then cease, even without 
medication, and that the matter discharged is purely 
feculent, and has not the least resemblance to chol- 
eraic discharges. However, there is nothing re- 
markable in the fact that some of the cases of " chol- 
erine" should be followed by the supervention of 
real cholera, since we find the latter attacking pa- 
tients extremely ill of various fevers during any of 
their stages, at their beginning, middle or end; such 
as variola, typhus, etc. 

265. In these cases of diarrhoea it will be well to 
give the patient an opiate, one grain of opium, or 
thirty drops of laudanum, in a draught of some cor- 
dial, spirit or carminative mixture — but not more 
than one grain or its equivalent. The patient ought 
to lie down comfortably warm, and remain as quiet 
as possible. Quietude is particularly called for in 
every kind of bowel complaint, for exercise or mo- 
tion increases the peristaltic movement of the in- 
testines, which, of itself, keeps up an irritation and 
the frequency of the dejections. 






TREATMENT. 201 

These two elements of treatment — the opium and 
the quietude — will be sure to moderate if not arrest 
the passages. The practitioner on his next visit to 
the patient, at the expiration of three or four hours, 
will find him better, and ought, with a cheerful coun- 
tenance, to encourage his patient and assure him that 
his case is under control. The relief that the patient 
now experiences, and the hopeful assurance of his 
physician, will calm that anxiety which was a large 
cause of the bowel complaint. 

Should there remain a tendency to purgation still, 
the same dose may, or rather ought to be repeated, 
which, with a persistence of repose, moderate warmth, 
and a few hours of sleep, will produce some twelve 
or more hours' suspension of the complaint. Should 
the practitioner, after this interval of relief, judge 
proper to move the bowels gently, with a view of dis- 
charging any of the diarrhoeic matter that he may 
suppose has remained, he may do so by means of a 
small dose of castor-oil, or a little compound tincture 
of rhubarb. When this has operated to his satisfac- 
tion, he may repeat the anodyne already prescribed, 
in order to completely calm the intestinal relaxation. 
There are few cases that will not readily yield to this 
soothing treatment. No irritating laxative — such as 
salts, magnesia, senna, or any included under the 



202 ASIATIC CHOLERA. 

names purgative, cathartic, drastic — should be per- 
mitted to be taken. 

266. When the relax has been suppressed the 
patient may be allowed to leave his bed, should he be 
desirous of so doing; still, it must be borne in mind 
that repose of the body gives repose to the intestines. 
He may be allowed a reasonable amount of suste- 
nance, and rather of that kind he has been habituated 
to and for which he has an appetite; but thin gruel, 
weak broths and slops had better be dispensed with. 
A small glass of any agreeable cordial ought to be 
taken, or a glass of good wine, such as Madeira, 
Teneriffe or Port, any sound old Spanish wine; but 
let him shun that villainous compound, now so fash- 
ionable, sold under the name of Sherry. This last 
named wine, even when not adulterated, which is 
never the case now, is at best a shabby substitute for 
the warm southern wines already recommended. As 
regards the light French wines, they are too watery 
and destitute of body, as it is called, to be useful 
as an auxiliary to the medical treatment of the diar- 
rhoea under consideration. Shun groceries, retail or 
wholesale, if possible, for neither purity nor truth re- 
side in those haunts of adulteration. Should difficulty 
be experienced in procuring good wine, dispense with 
it, and make some kind of palatable cordial or punch, 
with good spirits. 



TREATMENT. 203 

267. Astounding cases, and cases without dis- 
charges, always terminate rapidly in death; conse- 
quently they have no sequel. On dissection, no lesion 
of any kind can be detected; the patient has been 
simply poisoned. 

268. Cases accompanied with rapid and copious 
discharges, but in which the impulse of the heart is 
only weakened, the capillary circulation, particularly 
that portion which belongs to the veins, is still car- 
ried on, although feebly, no cyanosis existing, and 
little or no cramps complained of, will run their 
course to its termination in a short time, not much 
over, or even less, than six to twelve hours. Soon 
after the gastric discharges and that by the skin 
have ceased, the patient commences to repose, and 
w^armth returns; he will fall into a refreshing sleep, 
out of which he awakens perfectly restored to health, 
excepting some slight weakness experienced on exer- 
cise, and loss of his usual fullness, both of which are 
soon restored; he is able to and does go about, feel- 
ing well, the next day. 

269. Such a case, without premonition, sudden, 
severe, rapid in its course, termination and recovery, 
leaving no trace of its fury discoverable in the sys- 
tem, goes far to support the statement, cholera is 
not a disease; but that the disorder must be attrib- 
uted to some transient cause — a poison received 



204 ASIATIC CHOLERA. 

from without, the potency of which is variable in 
different persons, astounding in some, severe in 
others, less in many. 

270. There are cases to all appearance of the same 
degree of severity as described in Sec. 268, and 
which recover in the same way, but in which debility 
is more marked, gradually increases day by day 
until in three, four, or five days the patient sinks 
without a struggle. 

271. Similar cases, which have in addition a slight 
cyanosis, do not recover so rapidly and completely as 
268; but advance slowly in warmth and in conva- 
lescence to ultimate perfect recovery. Cyanosis in- 
dicates a profound impression made by the poison. 
These patients require repose, good nursing, a judi- 
cious use of cordials, light bitter infusions and careful 
doses of nourishment. Many of these cases after 
struggling along for a few days, giving hope, have to 
yield to a failing economy that has suffered more than 
it can resist. 

272. Severe cases, accompanied with a degree of 
cyanosis greater than in 271, occasionally weather 
the choleraic storm, followed by a strong effort of 
the constitution to convalesce. The pulse is feeble, 
the temperature slowly returns, the stasis in the 
skin diminishes in color from leaden to light purple, 
and in a few days to that of a weak scarlatina. The 



TREATMENT. 205 

eyes are less deeply set in the orbits than they were; 
the conjunctivae may appear slightly pinkish; the 
corneas are moist, but not sufficiently so to give the 
clear sheen seen in health, since the lachrymal secre- 
tion is scanty, as are all other secretions; urine is 
formed in small quantity, and strangury has ceased, 
abdominal contractions no longer pressing the base 
of the bladder into the meatus. (Sec. 135.) Thirst 
continues, because repletion of fluid is not yet com- 
plete; should the patient sleep with the mouth open, 
or keep it open while awake, the tongue becomes dry 
and rough, even brown colored; there is little 
appetite excepting for fluids, a little of which, with 
the nutriment that happens to be mixed with it, may 
pass the pylorus in some degree digested, perhaps, 
and which will furnish material for a scanty stool, 
not much affected with bile. The temperature of the 
surface is low, but as the skin is dry and cannot 
evaporate, it gives the sensation of a degree of heat 
that does not exist in reality; neither is this sensation 
of heat, nor the thirst, nor the parched mouth, due to 
fever — there is none. I closely watched several 
cases, particularly those of two ladies. The mind 
was slightly blunted, it is true, and like in fevers the 
patients looked slightly anxious, but were quite clear 
in mind to the last. They were rather restless, soon 
weary of one position; one would get up of herself, 
10 



206 ASIATIC CHOLERA. 

sit on her chair for a while, say but little, and return 
to bed; none complained of that false heat so con- 
stantly present in sensation during colliquation. One 
of these died on the 10th day, with her senses, as did 
the other on the 12th. Some such patients gradually 
recovered, much deteriorated in constitution for 
some months. 

The treatment of alleged typhoid state ought to 
be principally expectant. Husband the strength of 
the patient by avoiding any thing that can fatigue, 
waste, or exhaust the patient. Give such nutriment 
as the appetite prefers, and in such quantities as the 
stomach can master, not more. Palatable fluids, and 
now, light French wines freely, unless disagreeable 
to the patient; in this case give cordials at judicious 
intervals. Tepid baths, when the patient can get 
into them without fatigue; in their stead, sponging 
frequently. This external wetting will contribute to 
supply the watery waste that has taken place, will 
aerate the cyanosed surface, and prove a grateful 
anodyne to the feelings. Never give a pharmaceutical 
stimulant when a natural one, like wine, can be had. 
Shun medication, so-called. 



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